Provider Demographics
NPI:1205998531
Name:LERCHEN, MELANIE FUSS (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:FUSS
Last Name:LERCHEN
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:LYNN
Other - Last Name:FUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3016 CENTRAL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1188
Mailing Address - Country:US
Mailing Address - Phone:206-734-0266
Mailing Address - Fax:
Practice Address - Street 1:4305 N LINCOLN AVE
Practice Address - Street 2:SUITE T
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1711
Practice Address - Country:US
Practice Address - Phone:773-355-8617
Practice Address - Fax:773-304-3567
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional