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General NPI Number Information
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NPI Number | 1457518805
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Entity Type | Individual
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Provider Name | MELINDA SUE MATHEWS MA, LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 116 S YORK RD SUITE 215
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City | ELMHURST
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State | IL
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Zip | 60126-3432
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Country | US
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Telephone | 630-204-3160
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Fax | 630-941-7944
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Provider Business Mailing Address
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Address Line | 109 LAKESIDE DR APARTMENT 232
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City | SAINT CHARLES
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State | IL
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Zip | 60174-7903
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Country | US
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Telephone | 630-443-8135
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Fax | 630-941-7944
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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 | 180006899
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License Number State | IL
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