Healthcare Provider Details

I. General information

NPI: 1912503731
Provider Name (Legal Business Name): FELICIA MUHAMMAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 S BELL AVE
CHICAGO IL
60636-3624
US

IV. Provider business mailing address

7320 S BELL AVE
CHICAGO IL
60636-3624
US

V. Phone/Fax

Practice location:
  • Phone: 773-430-1514
  • Fax:
Mailing address:
  • Phone: 773-430-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178010947
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178010947
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178010947
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number178010947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: