Provider Demographics
NPI:1366196842
Name:STITTS, MELANESE
Entity type:Individual
Prefix:
First Name:MELANESE
Middle Name:
Last Name:STITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4063
Mailing Address - Country:US
Mailing Address - Phone:331-332-0657
Mailing Address - Fax:
Practice Address - Street 1:2909 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4063
Practice Address - Country:US
Practice Address - Phone:331-332-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral