Provider Demographics
NPI:1073887295
Name:GLANS, KARIN A (MFT)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:A
Last Name:GLANS
Suffix:
Gender:F
Credentials:MFT
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 63
Mailing Address - Street 2:
Mailing Address - City:RIO NIDO
Mailing Address - State:CA
Mailing Address - Zip Code:95471-0063
Mailing Address - Country:US
Mailing Address - Phone:760-707-7682
Mailing Address - Fax:
Practice Address - Street 1:14987 CANYON SEVEN RD
Practice Address - Street 2:
Practice Address - City:RIO NIDO
Practice Address - State:CA
Practice Address - Zip Code:95471
Practice Address - Country:US
Practice Address - Phone:760-707-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist