Provider Demographics
NPI:1881608081
Name:GLOVER, MARK DWAIN (DMIN, LMFT, NCAC 1)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DWAIN
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DMIN, LMFT, NCAC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1844
Mailing Address - Country:US
Mailing Address - Phone:316-264-8800
Mailing Address - Fax:316-264-8809
Practice Address - Street 1:333 S GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1844
Practice Address - Country:US
Practice Address - Phone:316-264-8800
Practice Address - Fax:316-264-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS642 AND 643101YA0400X
101YP1600X
KS677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist