Provider Demographics
NPI:1013535152
Name:FRESIA, GLYNIS (MS, LPC)
Entity Type:Individual
Prefix:
First Name:GLYNIS
Middle Name:
Last Name:FRESIA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 N KENMORE AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5492
Mailing Address - Country:US
Mailing Address - Phone:312-420-7745
Mailing Address - Fax:833-672-3415
Practice Address - Street 1:9900 SPECTRUM DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4555
Practice Address - Country:US
Practice Address - Phone:312-420-7745
Practice Address - Fax:833-672-3415
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health