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General NPI Number Information
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NPI Number | 1407597776
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Entity Type | Individual
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Provider Name | MELANIE MCCUMMISKEY LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2022
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 75 EXECUTIVE DR STE 337
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City | AURORA
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State | IL
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Zip | 60504-8152
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Country | US
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Telephone | 314-442-6183
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 N PRAIRIE VIEW DR
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City | KANKAKEE
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State | IL
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Zip | 60901-7398
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Country | US
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Telephone | 815-278-0575
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178017942
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License Number State | IL
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