Provider Demographics
NPI:1194152769
Name:SHRYOCK, ANDREA LYNN (LCPC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYNN
Last Name:SHRYOCK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKEYE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-5722
Mailing Address - Country:US
Mailing Address - Phone:217-415-2140
Mailing Address - Fax:
Practice Address - Street 1:128 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2657
Practice Address - Country:US
Practice Address - Phone:800-773-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006626101YP2500X
IL178-003130101YP2500X
IL228311101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool