Provider Demographics
NPI:1326183807
Name:ARCHER, GLENN D (EDD, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:ARCHER
Suffix:
Gender:M
Credentials:EDD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BEL AIR BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3513
Mailing Address - Country:US
Mailing Address - Phone:251-476-9994
Mailing Address - Fax:251-476-9928
Practice Address - Street 1:601 BEL AIR BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3513
Practice Address - Country:US
Practice Address - Phone:251-476-9994
Practice Address - Fax:251-476-9928
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL531101YP2500X
AL3106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL103308Medicare UPIN
AL11688099Medicare UPIN