Organization Name: | MELON-GRACE PSYCHOLOGICAL SERVICES |
NPI Number: | 1053448662 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM MELON (PRESIDENT) |
Mailing Address: | 911 N Elm St Suite 316 Hinsdale |
State: | IL US |
Postal Code: | 605213634 |
Phone Number: | 6309209113 |
Fax Number: | |
NPI Enumeration Date: | 02/28/2007 |
NPI Last Update Date: | 09/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 060007829 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |