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General NPI Number Information
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NPI Number | 1053546499
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Entity Type | Organization
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Legal Business Name | HEART & SOUL THERAPIES, PC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 2604 E DEMPSTER ST SUITE 306
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-827-8297
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Fax |
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Provider Business Mailing Address
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Address Line | 2604 E DEMPSTER ST SUITE 306
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City | PARK RIDGE
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State | IL
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Zip | 60068-8412
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Country | US
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Telephone | 847-827-8297
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAUREEN A ROSE
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Credential | LCSW
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Telephone | 847-827-8297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178-005466
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-002572
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License Number State | IL
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