Provider Demographics
NPI:1073378964
Name:GRAND QUALITY COUNSELING WITH GLASER BURKHARDT, LMFT, INC
Entity Type:Organization
Organization Name:GRAND QUALITY COUNSELING WITH GLASER BURKHARDT, LMFT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLASER
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:IV
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-605-7911
Mailing Address - Street 1:7177 BROCKTON AVENUE
Mailing Address - Street 2:109
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2632
Mailing Address - Country:US
Mailing Address - Phone:951-605-7911
Mailing Address - Fax:951-729-5380
Practice Address - Street 1:7177 BROCKTON AVENUE
Practice Address - Street 2:109
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2632
Practice Address - Country:US
Practice Address - Phone:951-605-7911
Practice Address - Fax:951-605-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417285107Medicaid