MEDICARE: MRS. MELISSA BRENNAN ED.S, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.006276	IL

General Provider Information

NPI Number	:	1093853533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA BRENNAN ED.S, LCPC

Provider Business Mailing Address
First Line	:	101 BAYVIEW RD
Second Line	:
City	:	FOX RIVER GROVE
State	:	IL
Zip	:	60021-1501
Country	:	US
Telephone Number	:	847-302-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 AMERICAN WAY
Second Line	:	SUITE B
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3936
Country	:	US
Telephone Number	:	847-302-6488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	06/25/2013

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