MEDICARE: MS. CHERYL YVONNE GLENN LPC

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	101YP2500X	Professional Counselor	6401012804	MI

General Provider Information

NPI Number	:	1528731387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL YVONNE GLENN LPC

Provider Business Mailing Address
First Line	:	9005 W OQUENDO RD APT 2017
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1520
Country	:	US
Telephone Number	:	248-672-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	9005 W OQUENDO RD APT 2017
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1520
Country	:	US
Telephone Number	:	248-672-8882
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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