=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629133616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE L. GLORIA LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2006
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N WALL ST
-----------------------------------------------------
City | BUHLER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67522-8039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-313-0768
-----------------------------------------------------
Fax | 972-874-0523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N WALL ST
-----------------------------------------------------
City | BUHLER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67522-8039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-313-0768
-----------------------------------------------------
Fax | 972-874-0523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 13459
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 31661
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------