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NPI Code Detail

MEDICARE: MR. JOHN GLISSON L.C.P.C.

MEDICARE: MR. JOHN GLISSON L.C.P.C.
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
1101YP2500XProfessional CounselorLCPC - 4996ID

General Provider Information

NPI Number : 1205273869
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN GLISSON L.C.P.C.
Provider Business Mailing Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-866-0045
Fax Number :
Provider Business Practice Location Address
First Line : 849 E FAIRVIEW AVE
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1806
Country : US
Telephone Number : 208-866-0045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2013
Last Update Date : 02/07/2016

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