Provider Demographics
NPI:1710490412
Name:ROSE, JOSHUA (LPC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ROSE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E DELAWARE PL APT 1103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 E DELAWARE PLACE
Practice Address - Street 2:APT 1103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6061
Practice Address - Country:US
Practice Address - Phone:954-579-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013396101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty