Provider Demographics
NPI:1295441913
Name:GLENN, CHIYA LYNETTE (LMHC)
Entity type:Individual
Prefix:MS
First Name:CHIYA
Middle Name:LYNETTE
Last Name:GLENN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 GOODMAN ST S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2539
Mailing Address - Country:US
Mailing Address - Phone:585-719-7130
Mailing Address - Fax:
Practice Address - Street 1:868 GOODMAN ST S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2539
Practice Address - Country:US
Practice Address - Phone:585-719-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY0141188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health