Nina Gryglas
Individual provider Active NPI Mental Health Counselor · Bannockburn, IL
NPI 1104565050 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1104565050
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 150.107662 (IL)
- Practice address
- 2211B Lakeside Dr
Bannockburn, IL 60015-1265 - Phone
- (847) 217-9381
- NPI assigned
- May 31, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150.107662 | IL | MD | Mental Health Counselor |
Interoperability endpoints
- nina@ammiraticounseling.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 150.107662 | IL | Yes |
Addresses
Primary practice location
2211B Lakeside Dr
Bannockburn, IL 60015-1265
Mailing address
2211B Lakeside Dr
Bannockburn, IL 60015-1265
Phone (210) 627-3656
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11-3677589 | Other | IL | LSW |
| 150.107662 | Other | IL | LSW |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Nina@ammiraticounseling.com |
Other providers in Bannockburn, IL
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- Brad K. Greenspan
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All providers in Bannockburn, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.