Provider Demographics
NPI:1851707640
Name:MCNALLY, MELANIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:PSYD
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 38
Mailing Address - Street 2:
Mailing Address - City:DEERTON
Mailing Address - State:MI
Mailing Address - Zip Code:49822-0038
Mailing Address - Country:US
Mailing Address - Phone:773-234-5303
Mailing Address - Fax:
Practice Address - Street 1:3400 W STONEGATE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1068
Practice Address - Country:US
Practice Address - Phone:773-234-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007259101YP2500X
IL071.009011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional