Healthcare Provider Details

I. General information

NPI: 1720788946
Provider Name (Legal Business Name): MELISSA LYNNE MELZER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N CLARK ST
CHICAGO IL
60640-4689
US

IV. Provider business mailing address

4250 N MARINE DR APT 308
CHICAGO IL
60613-1721
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-0205
  • Fax:
Mailing address:
  • Phone: 773-590-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: