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General NPI Number Information
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NPI Number | 1952069213
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Entity Type | Individual
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Provider Name | TRACI LYNN GLOVER LPC, LSW
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Gender | Female
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 750 EAST WARM SPRINGS AVENUE
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City | BOISE
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State | ID
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Zip | 83712-6475
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Country | US
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Telephone | 888-311-1883
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6802
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City | BOISE
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State | ID
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Zip | 83707-0802
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Country | US
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Telephone | 888-311-1883
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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 | LPC-4138
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-1689
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License Number State | ID
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