Provider Demographics
NPI:1992121545
Name:HANNON, MELISSA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 SUNNYBRAE AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-4113
Mailing Address - Country:US
Mailing Address - Phone:773-208-2208
Mailing Address - Fax:
Practice Address - Street 1:6623 SUNNYBRAE AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-4113
Practice Address - Country:US
Practice Address - Phone:773-208-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist