Basic Information
| Provider Information | |||||||||
| NPI: | 1184128035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLASSER | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | RENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 E FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925434512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514392939 | ||||||||
| FaxNumber: | 0514392940 | ||||||||
| Practice Location | |||||||||
| Address1: | 23115 RIDER ST | ||||||||
| Address2: | |||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925709723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516868500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2018 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.