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General NPI Number Information
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NPI Number | 1851947337
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Entity Type | Organization
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Legal Business Name | MELISSA ROOTH LLC
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE STE 1801
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City | CHICAGO
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State | IL
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Zip | 60601-3984
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Country | US
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Telephone | 847-922-2150
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 ASBURY AVE
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City | EVANSTON
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State | IL
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Zip | 60202-1172
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Country | US
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Telephone | 847-922-2150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA B ROOTH
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Credential | LCPC
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Telephone | 847-922-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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