Provider Demographics
NPI:1376101113
Name:FREE, DANIEL LYNN (MA LCPC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LYNN
Last Name:FREE
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 TIMBER MEADOWS PL
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5514
Mailing Address - Country:US
Mailing Address - Phone:618-219-6781
Mailing Address - Fax:
Practice Address - Street 1:131 HILLSBORO AVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1621
Practice Address - Country:US
Practice Address - Phone:314-246-9277
Practice Address - Fax:855-719-2556
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL178.011537101YP2500X
IL180.012522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional