Provider Demographics
NPI:1609329952
Name:MICHAEL W GLAVIN LMFT & ASSOCIATES LLC
Entity Type:Organization
Organization Name:MICHAEL W GLAVIN LMFT & ASSOCIATES LLC
Other - Org Name:CENTER FOR RELATIONAL TRANSFORMATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:312-672-1621
Mailing Address - Street 1:111 N WABASH AVE STE 1722
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2007
Mailing Address - Country:US
Mailing Address - Phone:312-470-0788
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1622
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3038
Practice Address - Country:US
Practice Address - Phone:312-470-0788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty