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NPI Code Detail

MEDICARE: MR. SHERMAN R. GLENN LMFT

MEDICARE: MR. SHERMAN R. GLENN LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC17827CA

General Provider Information

NPI Number : 1104845213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHERMAN R. GLENN LMFT
Provider Business Mailing Address
First Line : 911 E TUOLUMNE RD
Second Line :
City : TURLOCK
State : CA
Zip : 95382-1543
Country : US
Telephone Number : 209-668-4101
Fax Number : 209-668-3758
Provider Business Practice Location Address
First Line : 911 E TUOLUMNE RD
Second Line :
City : TURLOCK
State : CA
Zip : 95382-1543
Country : US
Telephone Number : 209-668-4101
Fax Number : 209-668-3758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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