Provider Demographics
NPI:1073747283
Name:LENCE, GREGORY GLENN (BA MHP)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:GLENN
Last Name:LENCE
Suffix:
Gender:M
Credentials:BA MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 WALNUT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-3211
Mailing Address - Country:US
Mailing Address - Phone:618-833-6875
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:618-658-2501
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health