Provider Demographics
NPI:1881617769
Name:GLENN, JOE EDGAR (LCMFT)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:EDGAR
Last Name:GLENN
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 WARD PKWY
Mailing Address - Street 2:STE 380
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2034
Mailing Address - Country:US
Mailing Address - Phone:816-361-5511
Mailing Address - Fax:816-362-5511
Practice Address - Street 1:8080 WARD PKWY
Practice Address - Street 2:STE 380
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2034
Practice Address - Country:US
Practice Address - Phone:816-361-5511
Practice Address - Fax:816-362-5511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO#20012011106H00000X
KS264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist