Provider Demographics
NPI:1124136197
Name:GLEAVES, NANCY L (MA, LCPC, NCAC II)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:GLEAVES
Suffix:
Gender:F
Credentials:MA, LCPC, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 W MAPLE ST RM 202
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3043
Mailing Address - Country:US
Mailing Address - Phone:708-422-2885
Mailing Address - Fax:708-422-7161
Practice Address - Street 1:3450 W MAPLE ST RM 202
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3043
Practice Address - Country:US
Practice Address - Phone:708-422-2885
Practice Address - Fax:708-422-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10523101YA0400X
IL180000863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)