Healthcare Provider Details

I. General information

NPI: 1033341391
Provider Name (Legal Business Name): MELINDA LUPFER YACHNIN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N WABASH AVE SUITE 3805
CHICAGO IL
60611-3591
US

IV. Provider business mailing address

405 N WABASH AVE SUITE 3805
CHICAGO IL
60611-3591
US

V. Phone/Fax

Practice location:
  • Phone: 312-409-4960
  • Fax:
Mailing address:
  • Phone: 312-409-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number180-005280
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-005280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: