Provider Demographics
NPI:1952971889
Name:BROWN, CARLY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CARLY
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:444 N NORTHWEST HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 N NORTHWEST HWY STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3277
Practice Address - Country:US
Practice Address - Phone:847-401-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health