Provider Demographics
NPI:1093022717
Name:SKINNER, MELISSA H (LCPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:H
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3923
Mailing Address - Country:US
Mailing Address - Phone:872-222-3132
Mailing Address - Fax:
Practice Address - Street 1:515 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-3923
Practice Address - Country:US
Practice Address - Phone:872-222-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health