Healthcare Provider Details

I. General information

NPI: 1619683257
Provider Name (Legal Business Name): WREN PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S WESTERN AVE SUITE 2
CHICAGO IL
60612-4682
US

IV. Provider business mailing address

612 S WESTERN AVE SUITE 2
CHICAGO IL
60612-4682
US

V. Phone/Fax

Practice location:
  • Phone: 312-217-2259
  • Fax:
Mailing address:
  • Phone: 312-217-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAREN LYNN GLAZA
Title or Position: OWNER
Credential: LCSW
Phone: 312-217-2259