Provider Demographics
NPI:1861846412
Name:GLOVER, JEREMY WESSEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:WESSEL
Last Name:GLOVER
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 1:920 S AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-1216
Mailing Address - Country:US
Mailing Address - Phone:806-236-3836
Mailing Address - Fax:
Practice Address - Street 1:920 S AUSTIN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-1216
Practice Address - Country:US
Practice Address - Phone:806-236-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551391041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker