Provider Demographics
NPI:1851657282
Name:GLORE, CLIFTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:
Last Name:GLORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 THOLOZAN AVE
Mailing Address - Street 2:APT. 1E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1737
Mailing Address - Country:US
Mailing Address - Phone:314-306-5717
Mailing Address - Fax:
Practice Address - Street 1:9 HILLTOP VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1106
Practice Address - Country:US
Practice Address - Phone:314-306-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110187761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical