Provider Demographics
NPI:1982941597
Name:DEEGE, BRANDY LYNN (LCPC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:DEEGE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LYNN
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2610 W RICHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-7112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:316 N 9TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2742
Practice Address - Country:US
Practice Address - Phone:217-222-8254
Practice Address - Fax:217-222-4512
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IL180.008357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional