Basic Information
| Provider Information | |||||||||
| NPI: | 1063519510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREVER | ||||||||
| FirstName: | ALECIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600021542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478389904 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600021542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478389904 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | IL | X | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | IL | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 04932457 | 01 | IL | BLUE CROSS/SHIELD | OTHER |