Active NPI
Scott Justin Glenn, L.M.F.T.
- Marriage & Family Therapist
- Warner Robins, GA
National Provider Identifier
1144693003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT001338
- Practice address
- 109 Osigian Blvd
Warner Robins, GA 31088-8922 - Phone
- (478) 449-1475
- NPI assigned
- Nov 1, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT001338 | GA | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | MFT001338 | GA |
Addresses
Primary practice location
109 Osigian Blvd
Warner Robins, GA 31088-8922
Mailing address
109 Osigian Blvd
Warner Robins, GA 31088-8922
Phone (478) 952-9726
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT001338 | GA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560297600000",
"number": "1144693003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 OSIGIAN BLVD",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310888922",
"telephone_number": "478-952-9726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 OSIGIAN BLVD",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310888922",
"telephone_number": "478-449-1475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "SCOTT",
"middle_name": "JUSTIN",
"credential": "L.M.F.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-11-01",
"last_updated": "2019-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "MFT001338",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "GA",
"license": "MFT001338",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warner Robins, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.