Provider Demographics
NPI:1972881092
Name:GLAVOR, AMBER T (MA, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:T
Last Name:GLAVOR
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 S AUSTRIAN PINE ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3879
Mailing Address - Country:US
Mailing Address - Phone:815-690-6566
Mailing Address - Fax:
Practice Address - Street 1:521 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6700
Practice Address - Country:US
Practice Address - Phone:815-690-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86584106H00000X
IL166001250106H00000X
CAIMF 72223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist