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NPI Code Detail

MEDICARE: CONNIE GLENN, LMFT, INDIVIDUAL AND FAMILY THERAPY, INC.

MEDICARE: CONNIE GLENN, LMFT, INDIVIDUAL AND FAMILY THERAPY, INC.
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1477265742
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONNIE GLENN, LMFT, INDIVIDUAL AND FAMILY THERAPY, INC.
Provider Business Mailing Address
First Line : 991 LOMAS SANTA FE DR
Second Line : SUITE C #462
City : SOLANA BEACH
State : CA
Zip : 92075
Country : US
Telephone Number : 760-282-4252
Fax Number :
Provider Business Practice Location Address
First Line : 990 HIGHLAND DR STE 314
Second Line :
City : SOLANA BEACH
State : CA
Zip : 92075-2438
Country : US
Telephone Number : 760-282-4252
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. CONNIE GLENN
Credential : LMFT
Telephone Number : 760-282-4252
Provider Enumeration Date : 12/19/2022
Last Update Date : 12/19/2022

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Directions to “CONNIE GLENN, LMFT, INDIVIDUAL AND FAMILY THERAPY, INC. ” Practice Location

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