Provider Demographics
NPI:1497210462
Name:GLENN, MARTINA (LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:GLENN
Suffix:
Gender:
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 PRINCESS ANNE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3630
Mailing Address - Country:US
Mailing Address - Phone:408-410-5966
Mailing Address - Fax:
Practice Address - Street 1:912 PRINCESS ANNE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3630
Practice Address - Country:US
Practice Address - Phone:408-410-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12303101YP2500X
CA124624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional