Provider Demographics
NPI:1356599534
Name:GLECKLER, GEORGE P (MFT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:GLECKLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 W MANCHESTER AVE # A316
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7100
Mailing Address - Country:US
Mailing Address - Phone:310-922-8838
Mailing Address - Fax:
Practice Address - Street 1:8040 W MANCHESTER AVE # A316
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7100
Practice Address - Country:US
Practice Address - Phone:310-922-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-30
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist