Provider Demographics
NPI:1922664598
Name:LOOKING GLASS THERAPEUTICS
Entity Type:Organization
Organization Name:LOOKING GLASS THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-849-6969
Mailing Address - Street 1:123 S RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4947
Mailing Address - Country:US
Mailing Address - Phone:630-849-6969
Mailing Address - Fax:
Practice Address - Street 1:648 N RIVER RD STE 104
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8952
Practice Address - Country:US
Practice Address - Phone:630-777-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty