MEDICARE: MR. GLEN RICHARD HILTON MS, 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
1	106H00000X	Marriage & Family Therapist	LMFT ASSOC 201187	TX

General Provider Information

NPI Number	:	1588836928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLEN RICHARD HILTON MS, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 541039
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-1039
Country	:	US
Telephone Number	:	832-800-4500
Fax Number	:	713-481-0210

Provider Business Practice Location Address
First Line	:	2855 MANGUM RD
Second Line	:	SUITE 465
City	:	HOUSTON
State	:	TX
Zip	:	77092-7493
Country	:	US
Telephone Number	:	832-800-4500
Fax Number	:	713-481-0210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	02/11/2011

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