Individual
KEVIN LLOYD GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1424 S STAPLEY DR, MESA, AZ 85204-5877
(480) 892-7403
(480) 892-6701
Mailing address
1424 S STAPLEY DR, MESA, AZ 85204-5877
(480) 892-7403
(480) 892-6701
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-15190
AZ
Other
Enumeration date
06/16/2016
Last updated
06/16/2016
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