MEDICARE: FOREST MORMAN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180016705	IL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	180016705	IL

General Provider Information

NPI Number	:	1689559122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FOREST MORMAN LCPC

Provider Business Mailing Address
First Line	:	8153 S WENTWORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-1238
Country	:	US
Telephone Number	:	773-616-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2217
Country	:	US
Telephone Number	:	312-226-7984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2025
Last Update Date	:	01/23/2026

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Directions to “ FOREST MORMAN LCPC” Practice Location

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