Provider Demographics
NPI:1225659220
Name:FERDMAN, MELISSA ANN (LCPC, CRC, CCM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:FERDMAN
Suffix:
Gender:F
Credentials:LCPC, CRC, CCM
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:FERDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, CRC, CCM
Mailing Address - Street 1:1902 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5819
Mailing Address - Country:US
Mailing Address - Phone:217-722-0750
Mailing Address - Fax:
Practice Address - Street 1:1902 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5819
Practice Address - Country:US
Practice Address - Phone:217-722-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001910101YP2500X
IL101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health