Healthcare Provider Details

I. General information

NPI: 1245859693
Provider Name (Legal Business Name): ASHLYNN KAYE PINNEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 TROY OFALLON RD
TROY IL
62294-2400
US

IV. Provider business mailing address

3 OAK DR STE B
MARYVILLE IL
62062-5635
US

V. Phone/Fax

Practice location:
  • Phone: 618-972-1568
  • Fax: 618-205-3561
Mailing address:
  • Phone: 618-972-1568
  • Fax: 618-205-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.017186
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: