MEDICARE: MS. ILENE GLANCE M.S. LMHC

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

General Provider Information

NPI Number	:	1558702530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ILENE GLANCE M.S. LMHC

Provider Business Mailing Address
First Line	:	2200 N FLORIDA MANGO RD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6404
Country	:	US
Telephone Number	:	561-623-0071
Fax Number	:	561-296-5287

Provider Business Practice Location Address
First Line	:	2200 N FLORIDA MANGO RD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6404
Country	:	US
Telephone Number	:	561-623-0071
Fax Number	:	561-296-5287

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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