Provider Demographics
NPI:1023208410
Name:GLOVER, TINA MARIE (PHD, CRC, LPC, LPCC)
Entity Type:Individual
Prefix:DR
First Name:TINA MARIE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PHD, CRC, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0371
Mailing Address - Country:US
Mailing Address - Phone:503-970-0299
Mailing Address - Fax:
Practice Address - Street 1:2355 STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4541
Practice Address - Country:US
Practice Address - Phone:210-503-9834
Practice Address - Fax:888-371-3076
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175348101YM0800X
OR02-11-101101YA0400X
101YM0800X
AL3787101YM0800X
ORC3006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY175348OtherLPCC
VA00085421OtherCERTIFIED REHABILITATION COUNSELOR
AL3787OtherLPC
VA013896OtherNAADAC, NCAC II
OR02-11-101OtherACCBO, CADC II
ORC3006OtherLPC