Doctor Name: | MR. GREGORY GLENN LENCE |
NPI Number: | 1073747283 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BA MHP |
License Number: | |
Business Practice Address: | 408 E Vine St Vienna, IL - 629951612 |
Business Phone Number: | 6186582611 |
Business Fax Number: | 6186582501 |
Mailing Address: | 100 Walnut Valley Ln, ANNA |
State: | IL |
Postal Code: | 629063211 |
Phone Number: | 6188336875 |
Fax Number: | |
NPI Enumeration Date: | 05/04/2009 |
NPI Last Update Date: | 05/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |