| Doctor Name: | MICHAEL EDWARD MINNELLA |
| NPI Number: | 1720216864 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | 180.005220 |
| Business Practice Address: | 8955 S Komensky Ave Hometown, IL - 604561221 |
| Business Phone Number: | 7084250661 |
| Business Fax Number: | |
| Mailing Address: | 8955 S Komensky Ave, HOMETOWN |
| State: | IL |
| Postal Code: | 604561221 |
| Phone Number: | 7084250661 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2009 |
| NPI Last Update Date: | 06/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180.005220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |