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General NPI Number Information
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NPI Number | 1013939313
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Entity Type | Individual
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Provider Name | MEL GLASS PH.D. LCSW MFT
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 26300 LA ALAMEDA #280
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6317
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Country | US
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Telephone | 949-951-0345
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Fax | 949-459-1108
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Provider Business Mailing Address
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Address Line | 26300 LA ALAMEDA SUITE 280
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6317
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Country | US
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Telephone | 949-951-0345
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Fax | 949-459-1108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS13942
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC19448
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License Number State | CA
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