Provider Demographics
NPI:1780718833
Name:GLASS, JOSHUA KYLE (MS COUNSELING, LMFT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KYLE
Last Name:GLASS
Suffix:
Gender:M
Credentials:MS COUNSELING, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 MARITIME DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-3661
Mailing Address - Country:US
Mailing Address - Phone:916-716-1795
Mailing Address - Fax:916-685-6826
Practice Address - Street 1:2358 MARITIME DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-3661
Practice Address - Country:US
Practice Address - Phone:916-716-1795
Practice Address - Fax:916-685-6826
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist