Provider Demographics
NPI:1003823519
Name:GLENN, EILEEN H (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:H
Last Name:GLENN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 DODGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3012
Mailing Address - Country:US
Mailing Address - Phone:847-372-3736
Mailing Address - Fax:847-733-1571
Practice Address - Street 1:708 CHURCH ST STE 247
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3840
Practice Address - Country:US
Practice Address - Phone:847-733-9661
Practice Address - Fax:847-733-1571
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional