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General NPI Number Information
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NPI Number | 1841990983
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Entity Type | Organization
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Legal Business Name | ROSARIUM PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3742 N MAGNOLIA AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60613-3846
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Country | US
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Telephone | 773-484-0329
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Fax |
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Provider Business Mailing Address
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Address Line | 3742 N MAGNOLIA AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60613-3846
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Country | US
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Telephone | 773-484-0329
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND PSYCHOTHERAPIST
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Name | KYLE EUGENE SHIVER
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Credential | LCPC
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Telephone | 773-484-0329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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