Provider Demographics
NPI:1114067188
Name:ABEL, GLENN W (MFTII)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:W
Last Name:ABEL
Suffix:
Gender:M
Credentials:MFTII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CITADEL DR STE 175
Mailing Address - Street 2:CONCEPT-7
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1577
Mailing Address - Country:US
Mailing Address - Phone:323-838-9566
Mailing Address - Fax:
Practice Address - Street 1:200 CITADEL DR STE 175
Practice Address - Street 2:CONCEPT-7
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1577
Practice Address - Country:US
Practice Address - Phone:323-838-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMS40204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health