Healthcare Provider Details

I. General information

NPI: 1205348703
Provider Name (Legal Business Name): ELIZABETH CASACLANG-MELO MA, LPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3976 N AVONDALE AVE
CHICAGO IL
60641-2900
US

IV. Provider business mailing address

3976 N AVONDALE AVE FL 2
CHICAGO IL
60641-2900
US

V. Phone/Fax

Practice location:
  • Phone: 847-462-6099
  • Fax: 847-628-6064
Mailing address:
  • Phone: 630-428-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30088
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.002996
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: