Provider Demographics
NPI:1629614219
Name:GILPIN-PARKS, LYNN (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GILPIN-PARKS
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 MONONA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3561
Mailing Address - Country:US
Mailing Address - Phone:608-286-1133
Mailing Address - Fax:
Practice Address - Street 1:5900 MONONA DR STE 200
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3561
Practice Address - Country:US
Practice Address - Phone:608-286-1133
Practice Address - Fax:608-440-2954
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6682-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health