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General NPI Number Information
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NPI Number | 1083672034
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Entity Type | Individual
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Provider Name | ROBERT FLYNN LCPC
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 205 COMMERCE DR STE C
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City | GRAYSLAKE
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State | IL
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Zip | 60030-1646
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Country | US
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Telephone | 847-293-1698
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SEXTANT DR
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City | THIRD LAKE
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State | IL
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Zip | 60030-2617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-002585
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180002585
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License Number State | IL
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