Provider Demographics
NPI:1417471533
Name:NICHOLSON, MELISSA CATHERINE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:CATHERINE
Other - Last Name:LUDZACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:15 SPINNING WHEEL RD.
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:952-292-6941
Mailing Address - Fax:630-974-6263
Practice Address - Street 1:15 SPINNING WHEEL RD.
Practice Address - Street 2:SUITE 125
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:952-292-6941
Practice Address - Fax:630-974-6263
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001234106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist