Provider Demographics
NPI:1881457505
Name:FLYNN, DEIRDRE A (LPC)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:A
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N VIRGINIA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3454
Mailing Address - Country:US
Mailing Address - Phone:815-265-6561
Mailing Address - Fax:224-330-1928
Practice Address - Street 1:101 N VIRGINIA ST STE 110
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3454
Practice Address - Country:US
Practice Address - Phone:815-265-6561
Practice Address - Fax:224-330-1928
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health