Provider Demographics
NPI:1376652537
Name:GLEICH, LISA M (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:GLEICH
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 1:9800 S KARLOV AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3450
Mailing Address - Country:US
Mailing Address - Phone:847-833-2907
Mailing Address - Fax:
Practice Address - Street 1:611 E STATE ST
Practice Address - Street 2:SUITE 108
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2372
Practice Address - Country:US
Practice Address - Phone:630-232-2181
Practice Address - Fax:630-232-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
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