Doctor Name: | ANN MELVIN |
NPI Number: | 1164882098 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180.008497 |
Business Practice Address: | 902 W Main St West Frankfort, IL - 628962210 |
Business Phone Number: | 6189376483 |
Business Fax Number: | 6189371440 |
Mailing Address: | 902 W Main St, WEST FRANKFORT |
State: | IL |
Postal Code: | 628962210 |
Phone Number: | 6189376483 |
Fax Number: | 6189371440 |
NPI Enumeration Date: | 03/04/2016 |
NPI Last Update Date: | 03/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.008497 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |