Provider Demographics
NPI:1740699487
Name:GLENN MOWBRAY, PSY.D.
Entity type:Organization
Organization Name:GLENN MOWBRAY, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-761-9775
Mailing Address - Street 1:3740 ATLANTIC AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3440
Mailing Address - Country:US
Mailing Address - Phone:562-761-9775
Mailing Address - Fax:
Practice Address - Street 1:3740 ATLANTIC AVE
Practice Address - Street 2:STE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3440
Practice Address - Country:US
Practice Address - Phone:562-761-9775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty