Healthcare Provider Details

I. General information

NPI: 1770167793
Provider Name (Legal Business Name): MELISA Y ALBARRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 GRAND AVE FL 1
WAUKEGAN IL
60085-2321
US

IV. Provider business mailing address

3010 GRAND AVE FL 1
WAUKEGAN IL
60085-2321
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-8031
  • Fax: 847-984-5673
Mailing address:
  • Phone: 847-377-8031
  • Fax: 847-984-5673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: