Individual
MRS. MARCIA GLEAVES FORREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LMFT
Contact information
Practice address
516 N MAIN ST, SUITE C, GLEN ELLYN, IL 60137-5175
(630) 627-2588
(630) 980-9242
Mailing address
516 N MAIN ST., SUITE C, GLEN ELLYN, IL 60137
(630) 627-2588
(630) 980-9242
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002232107
BCBS PROVIDER #
IL
Enumeration date
08/03/2006
Last updated
07/08/2007
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