Provider Demographics
NPI:1902001043
Name:GLESS, KAREN (MFT)
Entity Type:Individual
Prefix:DR
First Name:KAREN
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 1:3660 CLAIREMONT DR STE 9
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5969
Mailing Address - Country:US
Mailing Address - Phone:858-273-2980
Mailing Address - Fax:
Practice Address - Street 1:3660 CLAIREMONT DR STE 9
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5969
Practice Address - Country:US
Practice Address - Phone:858-273-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist