Provider Demographics
NPI:1669985214
Name:NASSER, FAROOQ (LCPC)
Entity type:Individual
Prefix:
First Name:FAROOQ
Middle Name:
Last Name:NASSER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:MR
Other - First Name:FAROOQ
Other - Middle Name:
Other - Last Name:NASSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:2800 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5107
Mailing Address - Country:US
Mailing Address - Phone:773-964-2002
Mailing Address - Fax:
Practice Address - Street 1:2800 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5107
Practice Address - Country:US
Practice Address - Phone:773-964-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.008453OtherINSURANCE
IL180008453OtherINSURANCE