Provider Demographics
NPI:1720744485
Name:FELICIA GLICK- OBERWISE DBA FELICIA GLICK
Entity Type:Organization
Organization Name:FELICIA GLICK- OBERWISE DBA FELICIA GLICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-835-5329
Mailing Address - Street 1:1340 REYNOLDS AVE STE 116-1020
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5551
Mailing Address - Country:US
Mailing Address - Phone:949-835-5329
Mailing Address - Fax:
Practice Address - Street 1:1340 REYNOLDS AVE STE 116-1020
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5551
Practice Address - Country:US
Practice Address - Phone:949-835-5329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty