Healthcare Provider Details

I. General information

NPI: 1184592024
Provider Name (Legal Business Name): GLOM OUTPATIENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W TOKAY ST STE A
LODI CA
95240-3965
US

IV. Provider business mailing address

3123 INDEPENDENCE DR
LIVERMORE CA
94551-7595
US

V. Phone/Fax

Practice location:
  • Phone: 925-999-4119
  • Fax:
Mailing address:
  • Phone: 925-999-4119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLEN TURNER
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 925-570-3282