Provider Demographics
NPI:1275384521
Name:FLOCKERZI, DEBORAH ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELAINE
Last Name:FLOCKERZI
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 1:10 WHITES PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-1860
Mailing Address - Country:US
Mailing Address - Phone:309-826-4528
Mailing Address - Fax:
Practice Address - Street 1:10 WHITES PL
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-1860
Practice Address - Country:US
Practice Address - Phone:309-826-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.150019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional