Individual provider Active NPI

Terry Glenn

  • Mental Health Counselor
  • Belleville, IL
National Provider Identifier
1699316877
Registry record updated Sep 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
178.011987 Issued in IL
Practice address
12 N 64TH St
Belleville, IL 62223-3808
Phone
(618) 887-4420
Fax
(618) 397-0093
NPI assigned
Sep 30, 2019
Last updated
Sep 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 178.001987 IL
Professional Counselor 101YP2500X 178.011987 IL
Mental Health Counselor 101YM0800X 178.011987 IL Primary

Addresses

Primary practice location

12 N 64TH St
Belleville, IL 62223-3808

Mailing address

1003 Martin Luther King Dr
Bloomington, IL 61701-1429
Phone (888) 924-3786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240226001270 IL Practitioner - Mental Health Counselor 9739524158 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Group practices
Chestnut Health Systems IncGroup PAC ID 1052393063, 31 clinicians

Practice addresses (Care Compare)

12 N 64TH St
Belleville, IL 62223-3809
Phone (618) 397-0900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178.001987ILMDCounselor
178.011987ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Chestnut Health Systems Inc. CurrentSince Jan 1, 2024 Accepting new patients
Chestnut Health Systems Inc CurrentSince Jan 1, 2024 Accepting new patients

Locations

12 N 64th St
Belleville, IL 62223
Phone (618) 397-0900

1003 Martin Luther King Dr
Bloomington, IL 61701
Phone (309) 827-6026

1003 Martin Luther King Dr
Ste Ii
Bloomington, IL 61701

50 Northgate Industrial Dr
Granite City, IL 62040
Phone (618) 512-1919

2148 Vadalabene Dr
Maryville, IL 62062
Phone (618) 288-3100

448 Wylie Dr
Normal, IL 61761
Phone (844) 973-6887

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790208000000",
    "number": "1699316877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 MARTIN LUTHER KING DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011429",
            "telephone_number": "888-924-3786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 N 64TH ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622233808",
            "telephone_number": "618-887-4420",
            "fax_number": "618-397-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "TERRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-30",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.001987",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.011987",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.011987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.