Organization
GLOW THERAPEUTIC SERVICES OF KENTUCKY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARISSA S HUBERT LCSW, CADC (OUTPATIENT THERAPIST)
(812) 453-8543
Entity
Organization
Contact information
Practice address
210 W 3RD ST, OWENSBORO, KY 42303-4121
(812) 453-8543
(270) 906-1150
Mailing address
210 W 3RD ST, OWENSBORO, KY 42303-4121
(812) 453-8543
(270) 906-1150
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
0981
KY
251S00000X
Community/Behavioral Health Agency
Primary
3407
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30603013
—
KY
01
—
P400019932
MEDICARE
KY
Enumeration date
04/10/2013
Last updated
10/04/2013
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