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General NPI Number Information
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NPI Number | 1003823519
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Entity Type | Individual
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Provider Name | EILEEN H GLENN L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 708 CHURCH ST STE 247
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City | EVANSTON
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State | IL
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Zip | 60201-3840
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Country | US
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Telephone | 847-733-9661
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Fax | 847-733-1571
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Provider Business Mailing Address
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Address Line | 2209 DODGE AVE
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City | EVANSTON
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State | IL
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Zip | 60201-3012
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Country | US
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Telephone | 847-372-3736
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Fax | 847-733-1571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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