Doctor Name: | BERTIN R GLENNON |
NPI Number: | 1629133004 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYCHOLOGICAL EXAMIN |
License Number: | LPC0000000289 |
Business Practice Address: | 310 E 8th St Suite C Chattanooga, TN - 374034062 |
Business Phone Number: | 4232657935 |
Business Fax Number: | 4232658204 |
Mailing Address: | 310 E 8th St, Suite C CHATTANOOGA |
State: | TN |
Postal Code: | 374034062 |
Phone Number: | 4232657935 |
Fax Number: | 4232658204 |
NPI Enumeration Date: | 12/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | LPC0000000289 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |