MEDICARE: MS. ANNA GLASS MA, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2514160115	MI
2	101YP2500X	Professional Counselor	2514160115	MI
3	101YP2500X	Professional Counselor	180-004116	IL
4	101YM0800X	Mental Health Counselor	180-004116	IL

General Provider Information

NPI Number	:	1033434238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA GLASS MA, LCPC

Provider Business Mailing Address
First Line	:	2811 W AINSLIE ST APT 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7861
Country	:	US
Telephone Number	:	773-501-8741
Fax Number	:

Provider Business Practice Location Address
First Line	:	3047 N LINCOLN AVE
Second Line	:	SUITE 400
City	:	CHICAGO
State	:	IL
Zip	:	60657-4999
Country	:	US
Telephone Number	:	773-501-8741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	01/20/2025

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