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General NPI Number Information
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NPI Number | 1366137010
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Entity Type | Individual
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Provider Name | MOLLY R MEJIA LPC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 5097 N ELSTON AVE STE 305
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City | CHICAGO
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State | IL
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Zip | 60630-2460
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Country | US
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Telephone | 773-683-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 1587 COVE DR
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City | PROSPECT HEIGHTS
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State | IL
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Zip | 60070-1910
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Country | US
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Telephone | 224-223-9817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.007801
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License Number State | IL
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