Healthcare Provider Details

I. General information

NPI: 1477483600
Provider Name (Legal Business Name): LYNN ABED-MAHMOUD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 W DEYOUNG ST STE 203C
MARION IL
62959-5899
US

IV. Provider business mailing address

4505 W DEYOUNG ST STE 203C
MARION IL
62959-5899
US

V. Phone/Fax

Practice location:
  • Phone: 618-283-2222
  • Fax: 844-270-4161
Mailing address:
  • Phone: 618-283-2222
  • Fax: 844-270-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022365
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: