Provider Demographics
NPI:1588347835
Name:LYNCH, DEBORAH MARY
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARY
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10651 HOLLOW TREE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7405
Mailing Address - Country:US
Mailing Address - Phone:312-890-7713
Mailing Address - Fax:
Practice Address - Street 1:19070 EVERETT BLVD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2018
Practice Address - Country:US
Practice Address - Phone:312-890-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002314101YA0400X
ILA-4110-0001-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)