Provider Demographics
NPI:1659901411
Name:SCOTT, GLENN ROBERT JR (MDIV, CAMS -LL)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ROBERT
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:MDIV, CAMS -LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:TARKIO
Mailing Address - State:MO
Mailing Address - Zip Code:64491-1142
Mailing Address - Country:US
Mailing Address - Phone:660-623-9000
Mailing Address - Fax:877-524-5680
Practice Address - Street 1:311 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1142
Practice Address - Country:US
Practice Address - Phone:660-623-9000
Practice Address - Fax:877-524-5680
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral