Provider Demographics
NPI:1235784968
Name:GLEN F PASTORES
Entity Type:Organization
Organization Name:GLEN F PASTORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PASTORES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:858-987-4848
Mailing Address - Street 1:1761 HOTEL CIR S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3318
Mailing Address - Country:US
Mailing Address - Phone:858-987-4848
Mailing Address - Fax:858-987-4849
Practice Address - Street 1:1761 HOTEL CIR S STE 380
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3318
Practice Address - Country:US
Practice Address - Phone:858-987-4848
Practice Address - Fax:858-987-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT94162OtherSTATE OF CALIFORNIA BOARD OF BEHAVIORAL SCIENCES