Provider Demographics
NPI:1972969830
Name:MARY LYNN MEYERS, LCSW, INC.
Entity type:Organization
Organization Name:MARY LYNN MEYERS, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-828-6066
Mailing Address - Street 1:1167 WILMETTE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2643
Mailing Address - Country:US
Mailing Address - Phone:847-818-6066
Mailing Address - Fax:
Practice Address - Street 1:1167 WILMETTE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2643
Practice Address - Country:US
Practice Address - Phone:847-818-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.014424251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health