Active NPI
Glenn Allen Peters, PHD
- Clinical Psychologist
- Encino, CA
National Provider Identifier
1386746279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 15757
- Practice address
- 16055 Ventura Blvd Ste 715
Encino, CA 91436-2610 - Phone
- (818) 475-2666
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC 12865 | CA | |
| Clinical Psychologist | 103TC0700X | PSY 15757 | CA | Primary |
Addresses
Primary practice location
16055 Ventura Blvd Ste 715
Encino, CA 91436-2610
Mailing address
16055 Ventura Blvd Ste 715
Encino, CA 91436-2610
Phone (818) 475-2666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 15757 | CA | MD | Clinical Psychologist |
| MFC 12865 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1386746279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16055 VENTURA BLVD STE 715",
"city": "ENCINO",
"state": "CA",
"postal_code": "914362610",
"telephone_number": "818-475-2666",
"fax_number": "818-783-0019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16055 VENTURA BLVD STE 715",
"city": "ENCINO",
"state": "CA",
"postal_code": "914362610",
"telephone_number": "818-475-2666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "GLENN",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC 12865",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 15757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
- Michael A Persky, M.D., F.A.C.S.
- Personal Touch Hospice Care Inc
- Laura Flicker Pescione, PH.D
- Peter C Nissler DDS a Dental Corp
- Peter R. Shrier, M.D.
- Timothy Allen Petersen, PSY.D.
- Kenneth P Peterson, MD
- Stephanie Marie Pettigrew
- Peyman Gravori, D.O. Inc., a Professional Medical Corporation
- Cynthia Pezeshgian, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.