MEDICARE: JAKE GLASSMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	153412

General Provider Information

NPI Number	:	1962189373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKE GLASSMAN

Provider Business Mailing Address
First Line	:	10845 BERNARDO RD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5483
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 S COAST HWY # 1839
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	619-900-4844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/26/2025

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Directions to “ JAKE GLASSMAN ” Practice Location

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