Melissa D. Wickes, MA, LCPC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

180.005608 Issued in IL

Practice address

1600 Lebanon Ave
Suite 108
Belleville, IL 62221-2491

Phone

(618) 444-1331

Fax

(618) 234-7003

NPI assigned

Jun 26, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372204800000",
    "number": "1437599149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 LEBANON AVE",
            "address_2": "SUITE 108",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622212491",
            "telephone_number": "618-444-1331",
            "fax_number": "618-234-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 LEBANON AVE",
            "address_2": "SUITE 108",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622212491",
            "telephone_number": "618-444-1331",
            "fax_number": "618-234-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKES",
        "first_name": "MELISSA",
        "middle_name": "D.",
        "name_prefix": "Mrs.",
        "credential": "MA, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.005608",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.005608",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "180.005608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Belleville, IL
• Providers in Belleville, IL by specialty
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.