Healthcare Provider Details

I. General information

NPI: 1164684858
Provider Name (Legal Business Name): MS. LEAH NATASHA GLASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 BLUEGRASS ST
PLUMAS LAKE CA
95961-8743
US

IV. Provider business mailing address

11716 ENTERPRISE DR
AUBURN CA
95603-3732
US

V. Phone/Fax

Practice location:
  • Phone: 916-208-9048
  • Fax:
Mailing address:
  • Phone: 530-889-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: