Individual
MARK W GLOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
2115 S FREMONT AVE, SUITE 3000, SPRINGFIELD, MO 65804-2239
(417) 820-7708
(417) 820-7951
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01548
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183800719
—
AR
05
—
1972590537
—
MO
05
—
200286220A
—
OK
05
—
493583108
—
MO
05
—
493583124
—
MO
01
—
680007342
RR MEDICARE
MO
01
—
P00251264
RR MEDICARE
—
01
—
P00894315
RR MEDICARE
AR
Enumeration date
09/29/2005
Last updated
09/11/2015
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