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General NPI Number Information
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NPI Number | 1558725150
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Entity Type | Organization
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Legal Business Name | BRUNER & GLEASON THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 04/09/2016
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Last Update Date | 04/09/2016
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Provider Practice Location Address
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Address Line | 1901 S CALUMET AVE UNIT 2308
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City | CHICAGO
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State | IL
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Zip | 60616-6044
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Country | US
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Telephone | 773-931-8379
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 S CALUMET AVE UNIT 2308
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City | CHICAGO
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State | IL
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Zip | 60616-6044
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Country | US
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Telephone | 773-931-8379
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MR. ANTON P GLEASON
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Credential | LCPC
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Telephone | 773-931-8379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1962860080
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License Number State | IL
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