Provider Demographics
NPI:1891086328
Name:GLOVER, REAGAN RAE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:REAGAN
Middle Name:RAE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 VALENCIA AVE
Mailing Address - Street 2:SUITE 6 &7
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4165
Mailing Address - Country:US
Mailing Address - Phone:831-460-2550
Mailing Address - Fax:
Practice Address - Street 1:3060 VALENCIA AVE
Practice Address - Street 2:SUITE 6 & 7
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4165
Practice Address - Country:US
Practice Address - Phone:831-460-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA53566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)