MEDICARE: MELISSA PALUCK 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	101YM0800X	Mental Health Counselor	178011673	IL
2	101YP2500X	Professional Counselor	180011977	IL

General Provider Information

NPI Number	:	1770941700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA PALUCK LCPC

Provider Business Mailing Address
First Line	:	115 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6075
Country	:	US
Telephone Number	:	847-463-1055
Fax Number	:	847-463-1055

Provider Business Practice Location Address
First Line	:	115 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6075
Country	:	US
Telephone Number	:	847-463-1055
Fax Number	:	847-463-1055

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

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	01/02/2019

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