Provider Demographics
NPI:1740775246
Name:SIDDIQUI, MOHAMMAD HUMAYUN (LCPC)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:HUMAYUN
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:HUGH
Other - Middle Name:
Other - Last Name:SIDDIQUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:1801 N MILL ST STE J
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N MILL ST STE J
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4869
Practice Address - Country:US
Practice Address - Phone:630-452-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional