Healthcare Provider Details

I. General information

NPI: 1811293541
Provider Name (Legal Business Name): MELISSA LEIGH GRUPE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PYOTT RD STE 102
LAKE IN THE HILLS IL
60156-9795
US

IV. Provider business mailing address

655 W IRVING PARK RD APT 4304
CHICAGO IL
60613-6300
US

V. Phone/Fax

Practice location:
  • Phone: 401-533-6245
  • Fax:
Mailing address:
  • Phone: 401-533-6245
  • Fax: 401-424-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180009158
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009158
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180009158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: