Provider Demographics
NPI:1386302123
Name:MELISSA MINEAR LCSW PLLC
Entity type:Organization
Organization Name:MELISSA MINEAR LCSW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-612-9736
Mailing Address - Street 1:4940 S EAST END AVE APT 15A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-6040
Mailing Address - Country:US
Mailing Address - Phone:312-612-9736
Mailing Address - Fax:
Practice Address - Street 1:4940 S EAST END AVE APT 15A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-6040
Practice Address - Country:US
Practice Address - Phone:312-612-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1073072575Medicaid