Individual
MR. GLENNON CHARLES DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED., LPC
Contact information
Practice address
214 S CLAY AVE, APT. 3, KIRKWOOD, MO 63122-4215
(314) 849-2989
Mailing address
214 S CLAY AVE, APT. 3, KIRKWOOD, MO 63122-4215
(314) 849-2989
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002525
MO
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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