Provider Demographics
NPI:1417285107
Name:BURKHARDT, GLASER F IV (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GLASER
Middle Name:F
Last Name:BURKHARDT
Suffix:IV
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2632
Mailing Address - Country:US
Mailing Address - Phone:951-225-4998
Mailing Address - Fax:951-729-6820
Practice Address - Street 1:7177 BROCKTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2632
Practice Address - Country:US
Practice Address - Phone:951-225-4998
Practice Address - Fax:951-729-6820
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49666106H00000X
CAIMF 45092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist