Provider Demographics
NPI:1457807752
Name:LUGO, MELISSA MARIA (PEL, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIA
Last Name:LUGO
Suffix:
Gender:F
Credentials:PEL, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 BETHANY ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3126
Mailing Address - Country:US
Mailing Address - Phone:815-264-2153
Mailing Address - Fax:
Practice Address - Street 1:2535 BETHANY ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3126
Practice Address - Country:US
Practice Address - Phone:815-264-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health