Provider Demographics
NPI:1366267841
Name:METCALF, MELISSA LAUREN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAUREN
Last Name:METCALF
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 1:1029 E 161ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1723
Mailing Address - Country:US
Mailing Address - Phone:708-227-1739
Mailing Address - Fax:
Practice Address - Street 1:1029 E 161ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1723
Practice Address - Country:US
Practice Address - Phone:708-227-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health