Provider Demographics
NPI:1578631339
Name:IRVING-KLASS, LYNN ELLEN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ELLEN
Last Name:IRVING-KLASS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W. WILLOW KNOLLS ROAD
Mailing Address - Street 2:SUITE 205A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-9200
Mailing Address - Country:US
Mailing Address - Phone:309-693-9003
Mailing Address - Fax:309-693-1761
Practice Address - Street 1:2001 W WILLOW KNOLLS DR
Practice Address - Street 2:SUITE 205A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1290
Practice Address - Country:US
Practice Address - Phone:309-693-9003
Practice Address - Fax:309-693-1761
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional