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General NPI Number Information
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NPI Number | 1477823136
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Entity Type | Organization
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Legal Business Name | CHRISTIAN THERAPY AND MEDIATION SERVICES, LLC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 4290 N MONROE ST
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City | HUTCHINSON
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State | KS
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Zip | 67502-2223
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Country | US
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Telephone | 620-662-1283
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Fax | 620-662-1347
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Provider Business Mailing Address
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Address Line | 4290 N MONROE ST
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City | HUTCHINSON
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State | KS
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Zip | 67502-2223
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Country | US
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Telephone | 620-662-1283
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Fax | 620-662-1347
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Authorized Official
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Title or Position | THERAPIST
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Name | DR. MARK DWAIN GLOVER
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Credential | DMIN, LCMFT, LCAC
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Telephone | 620-662-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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