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General NPI Number Information
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NPI Number | 1013535152
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Entity Type | Individual
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Provider Name | GLYNIS FRESIA MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 9900 SPECTRUM DR
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City | AUSTIN
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State | TX
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Zip | 78717-4555
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Country | US
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Telephone | 312-420-7745
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Fax | 833-672-3415
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Provider Business Mailing Address
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Address Line | 4129 N KENMORE AVE APT 1S
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City | CHICAGO
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State | IL
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Zip | 60613-5492
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Country | US
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Telephone | 312-420-7745
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Fax | 833-672-3415
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 78119
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License Number State | TX
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