Provider Demographics
NPI:1225185887
Name:MCHENRY, MELISSA (LCPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:114 WHITELAW AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095
Mailing Address - Country:US
Mailing Address - Phone:618-251-4225
Mailing Address - Fax:618-251-4586
Practice Address - Street 1:114 WHITELAW AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1911
Practice Address - Country:US
Practice Address - Phone:618-251-4225
Practice Address - Fax:618-251-4586
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health