Active NPI
Glenn Fleisch, PH.D., MFT
- Marriage & Family Therapist
- Vallejo, CA
National Provider Identifier
1568549251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC12608
- Practice address
- 526 Tennessee St
Vallejo, CA 94590-4431 - Phone
- (707) 644-5421
- Fax
- (530) 622-2793
- NPI assigned
- Nov 1, 2006
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC12608 | CA | Primary |
Addresses
Primary practice location
526 Tennessee St
Vallejo, CA 94590-4431
Mailing address
526 Tennessee St
Vallejo, CA 94590-4431
Phone (707) 644-5421
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 20, 2025 through Jun 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC12608 | CA | MD | Marriage & Family Therapist |
| 12608 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568549251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "526 TENNESSEE ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945904431",
"telephone_number": "707-644-5421",
"fax_number": "530-622-2793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "526 TENNESSEE ST",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945904431",
"telephone_number": "707-644-5421",
"fax_number": "530-622-2793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLEISCH",
"first_name": "GLENN",
"credential": "PH.D., MFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC12608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.