Provider Demographics
NPI:1730793449
Name:GLENDALE COUNSELING SERVICES
Entity type:Organization
Organization Name:GLENDALE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADC II
Authorized Official - Phone:323-533-8805
Mailing Address - Street 1:446 W STOCKER ST APT 12
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4363
Mailing Address - Country:US
Mailing Address - Phone:323-533-8805
Mailing Address - Fax:
Practice Address - Street 1:100 N BRAND BLVD STE 412
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2614
Practice Address - Country:US
Practice Address - Phone:323-533-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)