Provider Demographics
NPI:1912318619
Name:SEMPLE, MELISSA (LCPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SEMPLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13274 N 400TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:IL
Mailing Address - Zip Code:62479-2325
Mailing Address - Country:US
Mailing Address - Phone:309-706-3190
Mailing Address - Fax:
Practice Address - Street 1:13274 N 400TH ST
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:IL
Practice Address - Zip Code:62479-2325
Practice Address - Country:US
Practice Address - Phone:309-706-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional