MEDICARE: VANESSA ANNE GLATT LPCC

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	101YP2500X	Professional Counselor	CC01055	MN
2	101YP2500X	Professional Counselor	9012	CA

General Provider Information

NPI Number	:	1295104941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ANNE GLATT LPCC

Provider Business Mailing Address
First Line	:	2644 30TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3060
Country	:	US
Telephone Number	:	310-314-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2644 30TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3060
Country	:	US
Telephone Number	:	310-314-6200
Fax Number	:

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	01/22/2021

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