Provider Demographics
NPI:1821431628
Name:YOUR CHOICE
Entity Type:Organization
Organization Name:YOUR CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:571-421-9842
Mailing Address - Street 1:105 N MARION ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 N MARION ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1075
Practice Address - Country:US
Practice Address - Phone:571-421-9842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty