Provider Demographics
NPI:1891291035
Name:EBRAHIM, NOURA (LCPC)
Entity Type:Individual
Prefix:
First Name:NOURA
Middle Name:
Last Name:EBRAHIM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4926
Mailing Address - Country:US
Mailing Address - Phone:224-805-0008
Mailing Address - Fax:
Practice Address - Street 1:3525 W PETERSON AVE STE 522
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3317
Practice Address - Country:US
Practice Address - Phone:312-781-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional