Provider Demographics
NPI:1629340302
Name:GRAMLEY, CLARE STEVEN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:CLARE
Middle Name:STEVEN
Last Name:GRAMLEY
Suffix:
Gender:M
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:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-0441
Mailing Address - Country:US
Mailing Address - Phone:217-732-6225
Mailing Address - Fax:217-732-7272
Practice Address - Street 1:1700 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1047
Practice Address - Country:US
Practice Address - Phone:217-732-6225
Practice Address - Fax:217-732-7272
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional