Provider Demographics
NPI:1265025688
Name:ARMSTRONG, FRED LEE JR
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:LEE
Last Name:ARMSTRONG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 E 62ND ST APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3633
Mailing Address - Country:US
Mailing Address - Phone:773-306-3780
Mailing Address - Fax:
Practice Address - Street 1:957 E 62ND ST APT 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3633
Practice Address - Country:US
Practice Address - Phone:773-306-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional