Basic Information
| Provider Information | |||||||||
| NPI: | 1033252176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREVENGOED | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 559 E 161ST PL | ||||||||
| Address2: | |||||||||
| City: | SOUTH HOLLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604731618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084746211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6006 W 159TH STREET | ||||||||
| Address2: | |||||||||
| City: | OAK FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085357320 | ||||||||
| FaxNumber: | 7085357571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.