Healthcare Provider Details

I. General information

NPI: 1548702814
Provider Name (Legal Business Name): MELISSA SNYDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 N LASALLE BLVD COUNSELING- SWEETING
CHICAGO IL
60610
US

IV. Provider business mailing address

2448 W TAYLOR ST UNIT 1
CHICAGO IL
60612-4132
US

V. Phone/Fax

Practice location:
  • Phone: 312-329-2870
  • Fax:
Mailing address:
  • Phone: 312-504-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.012294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: