Provider Demographics
NPI:1215131925
Name:GLUSS, HOWARD MARK
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARK
Last Name:GLUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S BURNSIDE AVE STE 4B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3269
Mailing Address - Country:US
Mailing Address - Phone:323-935-9712
Mailing Address - Fax:323-935-5775
Practice Address - Street 1:321 S BEVERLY DR STE T
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4303
Practice Address - Country:US
Practice Address - Phone:323-935-9712
Practice Address - Fax:323-935-5775
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical