MEDICARE: MR. KEVIN PAYNE GLASSER MA, LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	8383	TX
2	101YP2500X	Professional Counselor	12634	TX

General Provider Information

NPI Number	:	1861494288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN PAYNE GLASSER MA, LPC

Provider Business Mailing Address
First Line	:	11999 KATY FWY
Second Line	:	SUITE 490
City	:	HOUSTON
State	:	TX
Zip	:	77079-1605
Country	:	US
Telephone Number	:	281-597-9291
Fax Number	:	281-597-9761

Provider Business Practice Location Address
First Line	:	11999 KATY FWY
Second Line	:	SUITE 490
City	:	HOUSTON
State	:	TX
Zip	:	77079-1605
Country	:	US
Telephone Number	:	281-597-9291
Fax Number	:	281-597-9761

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/10/2011

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