Provider Demographics
NPI:1619541216
Name:ANCHORED SERENITY THERAPEUTIC SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:ANCHORED SERENITY THERAPEUTIC SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW
Authorized Official - Phone:708-819-9796
Mailing Address - Street 1:1634 BARNSDALE RD APT 207
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1297
Mailing Address - Country:US
Mailing Address - Phone:708-819-9796
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD STE 246
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-3038
Practice Address - Country:US
Practice Address - Phone:708-576-4196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)