Provider Demographics
NPI:1609313600
Name:GLOTZ, MEGAN ENGE (LMFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ENGE
Last Name:GLOTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:SUZANNE
Other - Last Name:ENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:543 VIRGINIA ST APT C
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2999
Mailing Address - Country:US
Mailing Address - Phone:608-434-1642
Mailing Address - Fax:
Practice Address - Street 1:2100 N SEPULVEDA BLVD STE 32
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2958
Practice Address - Country:US
Practice Address - Phone:608-434-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF90365106H00000X
CA122007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist