Provider Demographics
NPI:1164684858
Name:GLASS, LEAH NATASHA
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:NATASHA
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11716 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3732
Mailing Address - Country:US
Mailing Address - Phone:530-889-6700
Mailing Address - Fax:
Practice Address - Street 1:1199 BLUEGRASS ST
Practice Address - Street 2:
Practice Address - City:PLUMAS LAKE
Practice Address - State:CA
Practice Address - Zip Code:95961-8743
Practice Address - Country:US
Practice Address - Phone:916-208-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist