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General NPI Number Information
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NPI Number | 1831549310
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Entity Type | Individual
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Provider Name | GLORIA MAUREEN DAHLQUIST L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 4405 W RIVERSIDE DR SUITE 203
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City | BURBANK
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State | CA
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Zip | 91505-4072
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Country | US
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Telephone | 949-244-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 954 TURTLE CREST DR
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City | IRVINE
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State | CA
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Zip | 92603-1012
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Country | US
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Telephone | 949-244-3674
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC 30142
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License Number State | CA
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