Organization
JISELLE ROMAN LCPC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JISELLE ROMAN LCPC (LICENSED CLINICAL PROFESSIONAL COUN)
(773) 627-7914
Entity
Organization
Contact information
Practice address
10720 PRINCESS AVE, CHICAGO RIDGE, IL 60415-2139
(773) 627-7914
(708) 575-6527
Mailing address
9631 S CICERO AVE # 1459, OAK LAWN, IL 60453-3137
(773) 627-7914
(708) 575-6527
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750703583
NPI 1
IL
Enumeration date
05/16/2022
Last updated
11/04/2023
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