Provider Demographics
NPI:1871762864
Name:MCGLYNN, PETER J (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MCGLYNN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1913
Mailing Address - Country:US
Mailing Address - Phone:310-652-5205
Mailing Address - Fax:
Practice Address - Street 1:565 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1913
Practice Address - Country:US
Practice Address - Phone:310-652-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36751106H00000X
CAMFC36751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist