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General NPI Number Information
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NPI Number | 1790266807
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL GLENN LPCC11331
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Gender | Male
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 140 W FRANKLIN ST STE 202
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City | MONTEREY
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State | CA
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Zip | 93940-2725
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Country | US
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Telephone | 831-521-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 226 WATSON ST APT B
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City | MONTEREY
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State | CA
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Zip | 93940-7903
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Country | US
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Telephone | 831-521-7222
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11331
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License Number State | CA
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