Individual
JEANINE MELLISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 PARK PL STE 11, BOURBONNAIS, IL 60914-1883
(815) 932-3395
Mailing address
323 W MULBERRY ST, PO BOX 322, WATSEKA, IL 60970-1568
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/19/2016
Last updated
03/20/2020
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