Provider Demographics
NPI:1497126148
Name:ROACH, HELOISA G R
Entity Type:Individual
Prefix:MRS
First Name:HELOISA
Middle Name:G R
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:STE 410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:888-726-7170
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:STE 410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:888-726-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor