| Wren Psychotherapy, Llc | |
|
612 S Western Ave Suite 2 Chicago IL 60612-4682 | |
| (312) 217-2259 | |
| Not Available |
| Full Name | Wren Psychotherapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 612 S Western Ave, Chicago, Illinois |
| Authorized Official Name and Position | Karen Lynn Glaza (OWNER) |
| Authorized Official Contact | 3122172259 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wren Psychotherapy, Llc 612 S Western Ave Suite 2 Chicago IL 60612-4682 Ph: (312) 217-2259 | Wren Psychotherapy, Llc 612 S Western Ave Suite 2 Chicago IL 60612-4682 Ph: (312) 217-2259 |
| NPI Number | 1619683257 |
|---|---|
| Provider Enumeration Date | 01/26/2023 |
| Last Update Date | 01/26/2023 |
| Certification Date | 01/26/2023 |
| Medicare PECOS PAC ID | 8123467438 |
|---|---|
| Medicare Enrollment ID | O20240419001101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619683257 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Karen Lynn Glaza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114426491 PECOS PAC ID: 4385883982 Enrollment ID: I20190830001404 |
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