Provider Demographics
NPI:1013002401
Name:ANNE ROSSEN INTEGRATIVE PSYCHOTHERAPY AND MORE, LLC
Entity Type:Organization
Organization Name:ANNE ROSSEN INTEGRATIVE PSYCHOTHERAPY AND MORE, LLC
Other - Org Name:KALEIDOSCOPE LIFEWORKS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST AND COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-433-8733
Mailing Address - Street 1:791 APPLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1201
Mailing Address - Country:US
Mailing Address - Phone:847-433-8733
Mailing Address - Fax:847-433-8734
Practice Address - Street 1:5 REVERE DR
Practice Address - Street 2:SUITE 238
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1566
Practice Address - Country:US
Practice Address - Phone:847-433-8733
Practice Address - Fax:847-433-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932599OtherBCBS PROVIDER NUMBER