Provider Demographics
NPI:1073799086
Name:CONNOR, GLORIANN P (MA LMFT)
Entity Type:Individual
Prefix:
First Name:GLORIANN
Middle Name:P
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:41945 BIG BEAR LAKE SUITE 200
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1927
Mailing Address - Country:US
Mailing Address - Phone:909-866-5070
Mailing Address - Fax:909-878-3228
Practice Address - Street 1:400 S 2ND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2854
Practice Address - Country:US
Practice Address - Phone:760-256-7279
Practice Address - Fax:760-256-7280
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor