Provider Demographics
NPI:1275167298
Name:BRASSEUR, DARCI LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:LYNN
Last Name:BRASSEUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5358
Mailing Address - Country:US
Mailing Address - Phone:810-347-1242
Mailing Address - Fax:
Practice Address - Street 1:40 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-3848
Practice Address - Country:US
Practice Address - Phone:630-235-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-015367101YP2500X
IL35201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional