Doctor Name: | MRS. MELISSA BRENNAN |
NPI Number: | 1093853533 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S, LCPC |
License Number: | 180.006276 |
Business Practice Address: | 1248 American Way Suite B Libertyville, IL - 600483936 |
Business Phone Number: | 8473026488 |
Business Fax Number: | |
Mailing Address: | 101 Bayview Rd, FOX RIVER GROVE |
State: | IL |
Postal Code: | 600211501 |
Phone Number: | 8473026488 |
Fax Number: | |
NPI Enumeration Date: | 02/04/2007 |
NPI Last Update Date: | 06/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.006276 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |