Provider Demographics
NPI:1346909355
Name:ROSE LANGE COUNSELING, PLLC
Entity Type:Organization
Organization Name:ROSE LANGE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-306-2699
Mailing Address - Street 1:1411 N KICKAPOO ST STE 225
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1861
Mailing Address - Country:US
Mailing Address - Phone:309-306-2699
Mailing Address - Fax:
Practice Address - Street 1:1411 N KICKAPOO ST STE 225
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1861
Practice Address - Country:US
Practice Address - Phone:309-306-2699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)