Provider Demographics
NPI:1548630692
Name:GLOWALLA, GEOFFREY DAVID (LMFT, MPA)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:DAVID
Last Name:GLOWALLA
Suffix:
Gender:M
Credentials:LMFT, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 FIRESTONE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-9323
Mailing Address - Country:US
Mailing Address - Phone:562-450-0620
Mailing Address - Fax:714-620-8132
Practice Address - Street 1:12440 FIRESTONE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-9323
Practice Address - Country:US
Practice Address - Phone:562-450-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111725106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist