Provider Demographics
NPI:1598383424
Name:GLENN COUNSELING CENTER
Entity Type:Organization
Organization Name:GLENN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SYNNESTVEDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-219-3513
Mailing Address - Street 1:1975 JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1615
Mailing Address - Country:US
Mailing Address - Phone:847-219-3513
Mailing Address - Fax:
Practice Address - Street 1:1975 JOHNS DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1615
Practice Address - Country:US
Practice Address - Phone:847-219-3513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty