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General NPI Number Information
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NPI Number | 1578057634
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Entity Type | Organization
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Legal Business Name | MELANIE DEL MUNDO, LTD
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1608 W COLONIAL PKWY STE 203
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City | INVERNESS
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State | IL
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Zip | 60067-4755
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Country | US
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Telephone | 312-593-5032
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Fax |
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Provider Business Mailing Address
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Address Line | 440 W COLFAX ST
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City | PALATINE
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State | IL
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Zip | 60067-2537
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Country | US
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Telephone | 312-593-5032
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELANIE DEL MUNDO
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Credential |
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Telephone | 312-593-5032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 180-004300
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License Number State | IL
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