Healthcare Provider Details

I. General information

NPI: 1366862187
Provider Name (Legal Business Name): ANDREW ROSS LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2014
Last Update Date: 05/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 SHERMAN AVE STE 5
EVANSTON IL
60201
US

IV. Provider business mailing address

1557 SHERMAN AVE STE 5
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-906-1621
  • Fax:
Mailing address:
  • Phone: 847-650-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.009613
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.011260
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011260
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: