Healthcare Provider Details

I. General information

NPI: 1902519515
Provider Name (Legal Business Name): LU ROCHA COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 N BROADWAY ST
CHICAGO IL
60613-2117
US

IV. Provider business mailing address

4071 N BROADWAY ST
CHICAGO IL
60613-2117
US

V. Phone/Fax

Practice location:
  • Phone: 773-217-8571
  • Fax: 872-231-2401
Mailing address:
  • Phone: 773-217-8571
  • Fax: 872-231-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOURDES ROCHA
Title or Position: FOUNDER
Credential: LCSW
Phone: 773-203-1328