MEDICARE: MS. NANCY L GLEAVES MA, LCPC, NCAC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10523	IL
2	101YP2500X	Professional Counselor	180000863	IL

General Provider Information

NPI Number	:	1124136197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY L GLEAVES MA, LCPC, NCAC II

Provider Business Mailing Address
First Line	:	3450 W MAPLE ST RM 202
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3043
Country	:	US
Telephone Number	:	708-422-2885
Fax Number	:	708-422-7161

Provider Business Practice Location Address
First Line	:	3450 W MAPLE ST RM 202
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3043
Country	:	US
Telephone Number	:	708-422-2885
Fax Number	:	708-422-7161

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	05/27/2025

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