Healthcare Provider Details

I. General information

NPI: 1225443716
Provider Name (Legal Business Name): RICHARD FLYNN LCPC, ATR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SKOKIE BLVD STE 222
NORTHBROOK IL
60062-4027
US

IV. Provider business mailing address

801 SKOKIE BLVD STE 222
NORTHBROOK IL
60062-4027
US

V. Phone/Fax

Practice location:
  • Phone: 773-991-6926
  • Fax: 847-785-1567
Mailing address:
  • Phone: 773-991-6926
  • Fax: 847-785-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.009082
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14-088
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009082
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: