Provider Demographics
NPI:1891959771
Name:CHOWDHURY, MOHAMMED (LCPC, CRC, MS)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:LCPC, CRC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 W FULLERTON AVE
Mailing Address - Street 2:SUITE # H
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-4366
Mailing Address - Country:US
Mailing Address - Phone:630-620-0801
Mailing Address - Fax:
Practice Address - Street 1:1433 W FULLERTON AVE
Practice Address - Street 2:SUITE # H
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-4366
Practice Address - Country:US
Practice Address - Phone:630-620-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health