Provider Demographics
NPI:1215747415
Name:GLYNIS K FRESIA COUNSELING & THERAPY
Entity type:Organization
Organization Name:GLYNIS K FRESIA COUNSELING & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLYNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:312-420-7745
Mailing Address - Street 1:6506 N ROBINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2414
Mailing Address - Country:US
Mailing Address - Phone:312-420-7745
Mailing Address - Fax:
Practice Address - Street 1:6506 N ROBINWOOD DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2414
Practice Address - Country:US
Practice Address - Phone:312-420-7745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty