Basic Information
| Provider Information | |||||||||
| NPI: | 1073799086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNOR | ||||||||
| FirstName: | GLORIANN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.A. LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1927 | ||||||||
| Address2: | 41945 BIG BEAR LAKE SUITE 200 | ||||||||
| City: | BIG BEAR LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923151927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098665070 | ||||||||
| FaxNumber: | 9098783228 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S 2ND AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923112854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602567279 | ||||||||
| FaxNumber: | 7602567280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2008 | ||||||||
| LastUpdateDate: | 06/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MFC 42055 | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.