Provider Demographics
NPI:1225443716
Name:FLYNN, RICHARD (LCPC, ATR)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SKOKIE BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4027
Mailing Address - Country:US
Mailing Address - Phone:773-991-6926
Mailing Address - Fax:847-785-1567
Practice Address - Street 1:801 SKOKIE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4027
Practice Address - Country:US
Practice Address - Phone:773-991-6926
Practice Address - Fax:847-785-1567
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009082101Y00000X, 101YP2500X
IL14-088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225443716Medicaid