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Individual

SCOTT JUSTIN GLENN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
L.M.F.T.

Contact information

Practice address
109 OSIGIAN BLVD, WARNER ROBINS, GA 31088-8922
(478) 449-1475
Mailing address
109 OSIGIAN BLVD, WARNER ROBINS, GA 31088-8922
(478) 952-9726

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MFT001338
GA
106H00000X
Marriage & Family Therapist
Primary
MFT001338
GA

Other

Enumeration date
11/01/2015
Last updated
06/12/2019
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