Provider Demographics
NPI:1033434238
Name:GLASS, ANNA (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 W CHASE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1211
Mailing Address - Country:US
Mailing Address - Phone:773-501-8741
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4999
Practice Address - Country:US
Practice Address - Phone:773-501-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional