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General NPI Number Information
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NPI Number | 1841629326
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Entity Type | Individual
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Provider Name | REBECCA TOMARA LYNN LCPC, CADC, CCTP-II
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Gender | Female
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1100 BEECH ST STE 3
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City | NORMAL
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State | IL
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Zip | 61761-1493
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Country | US
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Telephone | 309-585-5359
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Fax |
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Provider Business Mailing Address
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Address Line | 500 MAITLAND DR
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City | CARLOCK
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State | IL
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Zip | 61725-9514
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Country | US
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Telephone | 309-992-1881
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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 | 180.011217
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.011217
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 28926
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License Number State | IL
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