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General NPI Number Information
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NPI Number | 1588347835
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Entity Type | Individual
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Provider Name | DEBORAH MARY LYNCH
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 19070 EVERETT BLVD
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City | MOKENA
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State | IL
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Zip | 60448-2018
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Country | US
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Telephone | 312-890-7713
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Fax |
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Provider Business Mailing Address
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Address Line | 10651 HOLLOW TREE RD
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City | ORLAND PARK
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State | IL
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Zip | 60462-7405
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Country | US
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Telephone | 312-890-7713
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0002314
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A-4110-0001-A
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License Number State | IL
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