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NPI Code Detail

MEDICARE: JENNIFER L GLOCK LMFT

MEDICARE: JENNIFER L GLOCK 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 TherapistMT604FL

General Provider Information

NPI Number : 1225019680
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L GLOCK LMFT
Provider Business Mailing Address
First Line : 10232 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-6203
Country : US
Telephone Number : 904-260-0218
Fax Number : 904-292-1094
Provider Business Practice Location Address
First Line : 10232 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32257-6203
Country : US
Telephone Number : 904-260-0218
Fax Number : 904-292-1094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 07/08/2007

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Directions to “ JENNIFER L GLOCK LMFT” Practice Location

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