Healthcare Provider Details

I. General information

NPI: 1336952761
Provider Name (Legal Business Name): GLENDENE WOLF AMFT/APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31525 LINDERO CANYON RD UNIT 7
WESTLAKE VILLAGE CA
91361-4736
US

IV. Provider business mailing address

31525 LINDERO CANYON RD UNIT 7
WESTLAKE VILLAGE CA
91361-4736
US

V. Phone/Fax

Practice location:
  • Phone: 310-686-4292
  • Fax:
Mailing address:
  • Phone: 310-686-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: