Provider Demographics
NPI:1013939313
Name:GLASS, MEL (PHD LCSW MFT)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:
Last Name:GLASS
Suffix:
Gender:M
Credentials:PHD LCSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 LA ALAMEDA
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6317
Mailing Address - Country:US
Mailing Address - Phone:949-951-0345
Mailing Address - Fax:949-459-1108
Practice Address - Street 1:26300 LA ALAMEDA
Practice Address - Street 2:#280
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6317
Practice Address - Country:US
Practice Address - Phone:949-951-0345
Practice Address - Fax:949-459-1108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS139421041C0700X
CAMFC19448106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW13942Medicare ID - Type Unspecified