Provider Demographics
NPI:1982246294
Name:BUCK, LYNN (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:
Last Name:BUCK
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DREWSBURY LN
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1784
Mailing Address - Country:US
Mailing Address - Phone:815-531-4556
Mailing Address - Fax:
Practice Address - Street 1:20635 ABBEY WOODS CT N STE 309
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3217
Practice Address - Country:US
Practice Address - Phone:815-464-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178015209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178015209OtherIDFPR