Healthcare Provider Details

I. General information

NPI: 1376897074
Provider Name (Legal Business Name): LYNDA THROM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 WASHINGTON ST STE 1114
GURNEE IL
60031-2988
US

IV. Provider business mailing address

5101 WASHINGTON ST STE 1114
GURNEE IL
60031-2988
US

V. Phone/Fax

Practice location:
  • Phone: 224-408-0852
  • Fax: 224-353-4874
Mailing address:
  • Phone: 224-408-0852
  • Fax: 224-353-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number180008190
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180008190
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number180008190
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180008190
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number180008190
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1800008190
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008190
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008190
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: