Provider Demographics
NPI:1285453704
Name:GLOVER, TAYRON SR (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:TAYRON
Middle Name:
Last Name:GLOVER
Suffix:SR
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KATZ AVE APT 122
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1216
Mailing Address - Country:US
Mailing Address - Phone:973-801-7304
Mailing Address - Fax:
Practice Address - Street 1:122 KATZ AVE APT 122
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-1216
Practice Address - Country:US
Practice Address - Phone:973-801-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01832701101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor