Provider Demographics
NPI:1699823906
Name:STRICK, MELISSA R (LCPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:STRICK
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:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-1541
Mailing Address - Country:US
Mailing Address - Phone:708-334-9005
Mailing Address - Fax:708-946-3548
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE 206
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-334-9005
Practice Address - Fax:708-946-3548
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL549902OtherVALUE OPTIONS
IL01635532OtherBLUE CROSS BS OF ILLINOIS