1013002401 NPI number — ANNE ROSSEN INTEGRATIVE PSYCHOTHERAPY AND MORE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013002401 NPI number — ANNE ROSSEN INTEGRATIVE PSYCHOTHERAPY AND MORE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNE ROSSEN INTEGRATIVE PSYCHOTHERAPY AND MORE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013002401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
791 APPLE TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-433-8733
Provider Business Mailing Address Fax Number:
847-433-8734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 REVERE DR
Provider Second Line Business Practice Location Address:
SUITE 238
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-1566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-433-8733
Provider Business Practice Location Address Fax Number:
847-433-8734
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSSEN
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER/PSYCHOTHERAPIST AND COUNSELOR
Authorized Official Telephone Number:
847-433-8733

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  180006138 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04932599 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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