| Doctor Name: | MR. GLENNON CHARLES DOHERTY |
| NPI Number: | 1003939323 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED., LPC |
| License Number: | 002525 |
| Business Practice Address: | 214 S Clay Ave Apt. 3 Kirkwood, MO - 631224215 |
| Business Phone Number: | 3148492989 |
| Business Fax Number: | |
| Mailing Address: | 214 S Clay Ave, Apt. 3 KIRKWOOD |
| State: | MO |
| Postal Code: | 631224215 |
| Phone Number: | 3148492989 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 002525 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |