Provider Demographics
NPI:1427346790
Name:GLOVER, GERALDINE J (LPCC)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:J
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 CALLE LUMINOSO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5609
Mailing Address - Country:US
Mailing Address - Phone:505-424-7840
Mailing Address - Fax:
Practice Address - Street 1:1660 OLD PECOS TRL
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4779
Practice Address - Country:US
Practice Address - Phone:505-424-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000B6295Medicaid