Individual
MELVETTA BUCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
257 MINOCQUA ST, PARK FOREST, IL 60466-1942
(708) 937-5745
Mailing address
257 MINOCQUA ST, PARK FOREST, IL 60466-1942
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
07/27/2020
Last updated
12/09/2022
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