Provider Demographics
NPI:1477646354
Name:IRICK, DEANNA LYNN (MED NCC LPC MHSP MAC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LYNN
Last Name:IRICK
Suffix:
Gender:F
Credentials:MED NCC LPC MHSP MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37644-0602
Mailing Address - Country:US
Mailing Address - Phone:423-512-1682
Mailing Address - Fax:423-722-9333
Practice Address - Street 1:1316 W G ST STE 15
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2897
Practice Address - Country:US
Practice Address - Phone:423-895-9576
Practice Address - Fax:423-722-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC101Y00000X
TN1852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033962Medicaid
TN5441294Medicaid