MEDICARE: GLOWELL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	251B00000X	Case Management Agency
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
6	343800000X	Secured Medical Transport (VAN)
7	101YA0400X	Addiction (Substance Use Disorder) Counselor
8	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669963096	OTHER	AR	NPI

General Provider Information

NPI Number	:	1124580246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOWELL, LLC

Provider Business Mailing Address
First Line	:	1919 TAYLOR ST STE F1230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3973
Country	:	US
Telephone Number	:	501-683-9365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 TAYLOR ST STE F1230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3973
Country	:	US
Telephone Number	:	501-683-9365
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	BEATRICE B KLOKPAH
Credential	:	LCSW
Telephone Number	:	501-683-9365

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	01/02/2024

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Directions to “GLOWELL, LLC ” Practice Location

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