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General NPI Number Information
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NPI Number | 1215239926
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Entity Type | Individual
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Provider Name | MICKEY GLENN TENER M.S., LCMFT
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Gender | Male
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 7427 APENINNES ROAD
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City | FT RILEY
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State | KS
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Zip | 66442-7037
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Country | US
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Telephone | 785-239-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 7424 APENNINES DR
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City | FT RILEY
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State | KS
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Zip | 66442-7151
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Country | US
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Telephone | 785-239-7311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 256
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License Number State | KS
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