Healthcare Provider Details

I. General information

NPI: 1164368510
Provider Name (Legal Business Name): BONNIE GLAD MS COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LOCUST ST
ELDORADO IL
62930-1723
US

IV. Provider business mailing address

PO BOX 452
NORRIS CITY IL
62869-0452
US

V. Phone/Fax

Practice location:
  • Phone: 618-252-9036
  • Fax:
Mailing address:
  • Phone: 618-383-6539
  • 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:
Title or Position:
Credential:
Phone: