Provider Demographics
NPI:1770527350
Name:GLOVER, LESLIE Z (LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:Z
Last Name:GLOVER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-9641
Mailing Address - Country:US
Mailing Address - Phone:903-589-9000
Mailing Address - Fax:903-586-9200
Practice Address - Street 1:5656 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9641
Practice Address - Country:US
Practice Address - Phone:903-589-9000
Practice Address - Fax:903-586-9200
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82279LOtherBLUE CROSS
00T09ZMedicare PIN