Provider Demographics
NPI:1295567956
Name:GLAZE, ANNA LOUISE (MS, AMFT)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LOUISE
Last Name:GLAZE
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 STANFORD RANCH RD.
Mailing Address - Street 2:SUITE 2, #203
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765
Mailing Address - Country:US
Mailing Address - Phone:916-899-1965
Mailing Address - Fax:
Practice Address - Street 1:3031 STANFORD RANCH RD.
Practice Address - Street 2:SUITE 2, #203
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765
Practice Address - Country:US
Practice Address - Phone:916-899-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist