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NPI Code Detail

MEDICARE: COURTNEY AMANDA FOGHT LPC

MEDICARE: COURTNEY AMANDA FOGHT LPC
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
1101YP2500XProfessional Counselor178.016392IL

General Provider Information

NPI Number : 1720688526
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY AMANDA FOGHT LPC
Provider Business Mailing Address
First Line : 655 W IRVING PARK RD APT 2509
Second Line :
City : CHICAGO
State : IL
Zip : 60613-3113
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 180 N MICHIGAN AVE STE 1040
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7421
Country : US
Telephone Number : 312-346-5156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2020
Last Update Date : 10/30/2020

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Directions to “ COURTNEY AMANDA FOGHT LPC” Practice Location

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