Provider Demographics
NPI:1366137010
Name:MEJIA, MOLLY R (LPC)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:R
Last Name:MEJIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 COVE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1910
Mailing Address - Country:US
Mailing Address - Phone:224-223-9817
Mailing Address - Fax:
Practice Address - Street 1:5097 N ELSTON AVE STE 305
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2460
Practice Address - Country:US
Practice Address - Phone:773-683-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional