Provider Demographics
NPI:1457518805
Name:MATHEWS, MELINDA SUE (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LAKESIDE DR
Mailing Address - Street 2:APARTMENT 232
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7903
Mailing Address - Country:US
Mailing Address - Phone:630-443-8135
Mailing Address - Fax:630-941-7944
Practice Address - Street 1:116 S YORK RD
Practice Address - Street 2:SUITE 215
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3432
Practice Address - Country:US
Practice Address - Phone:630-204-3160
Practice Address - Fax:630-941-7944
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional