Provider Demographics
NPI:1275200479
Name:RUST, MELISSA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RUST
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N NORDICA AVE APT 209D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2804
Mailing Address - Country:US
Mailing Address - Phone:847-456-4792
Mailing Address - Fax:
Practice Address - Street 1:3205 N WILKE RD STE 112
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-0001
Practice Address - Country:US
Practice Address - Phone:847-456-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional