MEDICARE: MS. LEAH NATASHA GLASS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1164684858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH NATASHA GLASS

Provider Business Mailing Address
First Line	:	11716 ENTERPRISE DR
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-3732
Country	:	US
Telephone Number	:	530-889-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1199 BLUEGRASS ST
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-8743
Country	:	US
Telephone Number	:	916-208-9048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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