Healthcare Provider Details

I. General information

NPI: 1841629326
Provider Name (Legal Business Name): REBECCA TOMARA LYNN LCPC, CADC, CCTP-II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BEECH ST STE 3
NORMAL IL
61761-1493
US

IV. Provider business mailing address

500 MAITLAND DR
CARLOCK IL
61725-9514
US

V. Phone/Fax

Practice location:
  • Phone: 309-585-5359
  • Fax:
Mailing address:
  • Phone: 309-992-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011217
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.011217
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number28926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: