Healthcare Provider Details

I. General information

NPI: 1265359913
Provider Name (Legal Business Name): LAURA S GLICK MEYER AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA SYBIL GLICK AMFT

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR
BEVERLY HILLS CA
90210-4322
US

IV. Provider business mailing address

16060 VENTURA BLVD STE 150
ENCINO CA
91436-2761
US

V. Phone/Fax

Practice location:
  • Phone: 310-400-5643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: