MEDICARE: DR. JOE EDGAR GLENN LCMFT

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	#20012011	MO
2	106H00000X	Marriage & Family Therapist	264	KS

General Provider Information

NPI Number	:	1881617769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE EDGAR GLENN LCMFT

Provider Business Mailing Address
First Line	:	8080 WARD PKWY
Second Line	:	STE 380
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2034
Country	:	US
Telephone Number	:	816-361-5511
Fax Number	:	816-362-5511

Provider Business Practice Location Address
First Line	:	8080 WARD PKWY
Second Line	:	STE 380
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2034
Country	:	US
Telephone Number	:	816-361-5511
Fax Number	:	816-362-5511

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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