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General NPI Number Information
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NPI Number | 1902892847
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Entity Type | Individual
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Provider Name | GLEN C MARSEY LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1340 S SAM HOUSTON BLVD
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City | HOUSTON
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State | MO
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Zip | 65483-2045
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Country | US
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Telephone | 417-967-3755
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Fax | 417-967-2630
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Provider Business Mailing Address
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Address Line | PO BOX 817
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63702-0817
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Country | US
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Telephone | 573-335-4715
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Fax | 573-334-2303
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 000725
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License Number State | MO
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