NPIMap

Organization Active NPI

Glen Manor Counseling

  • Psychologist
  • Peoria, IL
National Provider Identifier
1972604411
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
GLEN MANOR COUNSELING
Practice address
914 Glen Ave
Suite #3
Peoria, IL 61614
Phone
(309) 693-2749
Fax
(309) 693-3894
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mrs. Julie A Ray, LCSWNPI 1265533798
Title
President Owner
Phone
(309) 693-2749

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

914 Glen Ave
Suite #3
Peoria, IL 61614

Mailing address

914 Glen Ave
Suite #3
Peoria, IL 61614
Phone (309) 693-2749

National Provider Directory

National Provider Directory

Locations

914 W Glen Ave
Ste 3
Peoria, IL 61614
Phone (309) 693-2749

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1972604411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 GLEN AVE",
            "address_2": "SUITE #3",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-693-2749",
            "fax_number": "309-693-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 GLEN AVE",
            "address_2": "SUITE #3",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-693-2749",
            "fax_number": "309-693-3894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN MANOR COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "309-693-2749",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.