Provider Demographics
NPI:1174237945
Name:DECORE, ANNE KIRSTI (LMFT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:KIRSTI
Last Name:DECORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5114
Mailing Address - Country:US
Mailing Address - Phone:203-915-8451
Mailing Address - Fax:
Practice Address - Street 1:1165 N CLARK ST STE 411
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7473
Practice Address - Country:US
Practice Address - Phone:312-725-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist