Provider Demographics
NPI:1144959222
Name:BURTON, MELANIE G (NBCC LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:G
Last Name:BURTON
Suffix:
Gender:F
Credentials:NBCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 MAPLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3980
Mailing Address - Country:US
Mailing Address - Phone:630-915-1219
Mailing Address - Fax:
Practice Address - Street 1:3525 W PETERSON AVE STE 522
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3317
Practice Address - Country:US
Practice Address - Phone:312-781-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional