MEDICARE: MRS. MELANIE FUSS LERCHEN M.A., LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180010150	IL

General Provider Information

NPI Number	:	1205998531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE FUSS LERCHEN M.A., LCPC

Provider Business Mailing Address
First Line	:	3016 CENTRAL ST APT 3
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1188
Country	:	US
Telephone Number	:	206-734-0266
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 N LINCOLN AVE
Second Line	:	SUITE T
City	:	CHICAGO
State	:	IL
Zip	:	60618-1711
Country	:	US
Telephone Number	:	773-355-8617
Fax Number	:	773-304-3567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/11/2016

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