| Doctor Name: | MANNIX GEORGE GLINES |
| NPI Number: | 1386606358 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.S.W. |
| License Number: | 3182133501 |
| Business Practice Address: | 6624 Old Mill Rd Stansbury Park, UT - 840749054 |
| Business Phone Number: | 8018243138 |
| Business Fax Number: | |
| Mailing Address: | 6624 Old Mill Rd, STANSBURY PARK |
| State: | UT |
| Postal Code: | 840749054 |
| Phone Number: | 8018243138 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2006 |
| NPI Last Update Date: | 09/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 3182133501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |