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General NPI Number Information
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NPI Number | 1881483238
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Entity Type | Individual
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Provider Name | MELINDA MORENO MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 3062 E 91ST ST
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City | CHICAGO
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State | IL
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Zip | 60617-4401
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Country | US
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Telephone | 773-791-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 3534 E 112TH ST
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City | CHICAGO
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State | IL
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Zip | 60617-7050
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Country | US
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Telephone |
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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 | 178.019769
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License Number State | IL
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