Provider Demographics
NPI:1912390568
Name:WEISS, LYNETTE (LCPC)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:MELLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1403
Mailing Address - Country:US
Mailing Address - Phone:217-820-2143
Mailing Address - Fax:
Practice Address - Street 1:415 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1403
Practice Address - Country:US
Practice Address - Phone:217-820-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL178.012890101YP2500X
IL180.014941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health