Provider Demographics
NPI:1982758405
Name:MELLOTT, CLAUDIA MARSHALL (LCPC, CADC)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:MARSHALL
Last Name:MELLOTT
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4615
Mailing Address - Country:US
Mailing Address - Phone:630-663-0793
Mailing Address - Fax:
Practice Address - Street 1:5147 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4615
Practice Address - Country:US
Practice Address - Phone:630-663-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17699101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional