Provider Demographics
NPI:1386381077
Name:MCKOWN, DENISE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:MCKOWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SW 12TH ST APT 9D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-1347
Mailing Address - Country:US
Mailing Address - Phone:618-402-0622
Mailing Address - Fax:
Practice Address - Street 1:4805 BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6702
Practice Address - Country:US
Practice Address - Phone:618-242-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-007874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health