Provider Demographics
NPI:1326215088
Name:GLOVER, CLAY CRAWFORD (MA)
Entity Type:Individual
Prefix:MR
First Name:CLAY
Middle Name:CRAWFORD
Last Name:GLOVER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CAMPUS VIEW DR
Mailing Address - Street 2:CATHOLIC CHARITIES 1411 N KICKAPOO
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656
Mailing Address - Country:US
Mailing Address - Phone:217-735-4864
Mailing Address - Fax:
Practice Address - Street 1:340 CAMPUS VIEW DR
Practice Address - Street 2:CATHOLIC CHARITIES 1411 N KICKAPOO
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2106
Practice Address - Country:US
Practice Address - Phone:217-735-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional