| Doctor Name: | SCOTT JUSTIN GLENN |
| NPI Number: | 1144693003 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.F.T. |
| License Number: | MFT001338 |
| Business Practice Address: | 172 Glenwood Springs Ter Eatonton, GA - 310246603 |
| Business Phone Number: | 4789529726 |
| Business Fax Number: | |
| Mailing Address: | 172 Glenwood Springs Ter, EATONTON |
| State: | GA |
| Postal Code: | 310246603 |
| Phone Number: | 4789529726 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2015 |
| NPI Last Update Date: | 11/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | MFT001338 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |