Provider Demographics
NPI:1851947337
Name:MELISSA ROOTH LLC
Entity Type:Organization
Organization Name:MELISSA ROOTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROOTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-922-2150
Mailing Address - Street 1:1240 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1172
Mailing Address - Country:US
Mailing Address - Phone:847-922-2150
Mailing Address - Fax:
Practice Address - Street 1:333 N MICHIGAN AVE STE 1801
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3984
Practice Address - Country:US
Practice Address - Phone:847-922-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty