Healthcare Provider Details

I. General information

NPI: 1275167298
Provider Name (Legal Business Name): DARCI LYNN BRASSEUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TIMBERLINE DR
LEMONT IL
60439-3848
US

IV. Provider business mailing address

549 RIDGEMOOR DR
WILLOWBROOK IL
60527-5358
US

V. Phone/Fax

Practice location:
  • Phone: 630-235-4573
  • Fax:
Mailing address:
  • Phone: 810-347-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35201
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178-015367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: