Provider Demographics
NPI:1689082653
Name:GLOVER, MARK (LAMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GLOVER
Suffix:
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 HIGHWAY 7
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3740
Mailing Address - Country:US
Mailing Address - Phone:612-810-3424
Mailing Address - Fax:
Practice Address - Street 1:14451 HIGHWAY 7
Practice Address - Street 2:SUITE 2A
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3740
Practice Address - Country:US
Practice Address - Phone:612-810-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist