Provider Demographics
NPI:1669827051
Name:GLOVER, LIESL L (PHD)
Entity Type:Individual
Prefix:
First Name:LIESL
Middle Name:L
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35888 CENTER RIDGE RD
Mailing Address - Street 2:STE. 5
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6002
Mailing Address - Country:US
Mailing Address - Phone:440-327-1800
Mailing Address - Fax:440-327-1533
Practice Address - Street 1:35888 CENTER RIDGE RD
Practice Address - Street 2:STE. 5
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-6002
Practice Address - Country:US
Practice Address - Phone:440-327-1800
Practice Address - Fax:440-327-1533
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist