Provider Demographics
NPI:1891918579
Name:GLOVER, BENNY ALVIN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BENNY
Middle Name:ALVIN
Last Name:GLOVER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ELIZABETH ST # 4
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4607
Mailing Address - Country:US
Mailing Address - Phone:707-447-4417
Mailing Address - Fax:707-447-4416
Practice Address - Street 1:419 ELIZABETH ST # 4
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4607
Practice Address - Country:US
Practice Address - Phone:707-447-4417
Practice Address - Fax:707-447-4416
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist