Active NPI
Louis Kevin Glenn, ED.M., LPC, CAC
- Mental Health Counselor
- Philadelphia, PA
National Provider Identifier
1245450683
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective May 20, 2012.
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- PC003865
- Practice address
- 4053 Balwynne Park Rd
Philadelphia, PA 19131-1601 - Phone
- (215) 432-6528
- Fax
- (215) 878-8281
- NPI assigned
- Apr 26, 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 | PC003865 | PA | Primary |
Addresses
Primary practice location
4053 Balwynne Park Rd
Philadelphia, PA 19131-1601
Mailing address
4053 Balwynne Park Rd
Philadelphia, PA 19131-1601
Phone (215) 432-6528
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7442832 | Other | PA | AETNA BEHAVIORAL HEALTH |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC003865 | PA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245450683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4053 BALWYNNE PARK RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311601",
"telephone_number": "215-432-6528",
"fax_number": "215-878-8281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4053 BALWYNNE PARK RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311601",
"telephone_number": "215-432-6528",
"fax_number": "215-878-8281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "LOUIS",
"middle_name": "KEVIN",
"credential": "ED.M., LPC, CAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": "PC003865",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA BEHAVIORAL HEALTH",
"identifier": "7442832",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.