Provider Demographics
NPI:1609166701
Name:GLESS, JENNIFER (MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GLESS
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 1:222 E OLIVE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5268
Mailing Address - Country:US
Mailing Address - Phone:909-798-7711
Mailing Address - Fax:909-798-5188
Practice Address - Street 1:222 E OLIVE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5268
Practice Address - Country:US
Practice Address - Phone:909-798-7711
Practice Address - Fax:909-798-5188
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist