Healthcare Provider Details

I. General information

NPI: 1689559122
Provider Name (Legal Business Name): FOREST MORMAN LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 W WASHINGTON BLVD
CHICAGO IL
60607-2217
US

IV. Provider business mailing address

8153 S WENTWORTH AVE
CHICAGO IL
60620-1238
US

V. Phone/Fax

Practice location:
  • Phone: 312-226-7984
  • Fax:
Mailing address:
  • Phone: 773-616-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180016705
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: