Individual
DEANNA R BLYTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3513 CRICKET AVE, NEW LENOX, IL 60451-9785
(815) 351-0208
Mailing address
3513 CRICKET AVE, NEW LENOX, IL 60451-9785
(815) 351-0208
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178015369
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178015369
ILLINOIS
IL
Enumeration date
11/15/2019
Last updated
11/27/2023
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