Active NPI
Glennon Charles Doherty, M.ED., LPC
- Mental Health Counselor
- Kirkwood, MO
National Provider Identifier
1003939323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 002525
- Practice address
- 214 S Clay Ave
Apt. 3
Kirkwood, MO 63122-4215 - Phone
- (314) 849-2989
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 002525 | MO | Primary |
Addresses
Primary practice location
214 S Clay Ave
Apt. 3
Kirkwood, MO 63122-4215
Mailing address
214 S Clay Ave
Apt. 3
Kirkwood, MO 63122-4215
Phone (314) 849-2989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002525 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003939323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 S CLAY AVE",
"address_2": "APT. 3",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224215",
"telephone_number": "314-849-2989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 S CLAY AVE",
"address_2": "APT. 3",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224215",
"telephone_number": "314-849-2989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "GLENNON",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "M.ED., LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "002525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.