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General NPI Number Information
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NPI Number | 1699663336
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Entity Type | Individual
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Provider Name | MELISSA RANDLE EL
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2656 W MONTROSE AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60618-1559
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Country | US
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Telephone | 773-267-5795
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Fax | 773-267-4787
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Provider Business Mailing Address
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Address Line | 2803 MINNESOTA AVE APT 2A
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City | BLUE ISLAND
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State | IL
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Zip | 60406-4107
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Country | US
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Telephone | 708-465-4628
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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 |
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License Number State |
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