Provider Demographics
NPI:1720227499
Name:GLOVER, JENNIFER RAE (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RAE
Other - Last Name:GLOVER-ROWLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 555
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538
Mailing Address - Country:US
Mailing Address - Phone:580-454-8000
Mailing Address - Fax:
Practice Address - Street 1:202 A ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538
Practice Address - Country:US
Practice Address - Phone:580-454-8000
Practice Address - Fax:580-454-8001
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional