Provider Demographics
NPI:1720734387
Name:GLICKSTERN, TROY LEWIS (LPC)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:LEWIS
Last Name:GLICKSTERN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1192
Mailing Address - Country:US
Mailing Address - Phone:847-624-2847
Mailing Address - Fax:
Practice Address - Street 1:175 E HAWTHORN PKWY STE 235
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1454
Practice Address - Country:US
Practice Address - Phone:847-624-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.0175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional