Healthcare Provider Details

I. General information

NPI: 1134745417
Provider Name (Legal Business Name): THOMAS JOSEPH NIMROD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 N SHERIDAN RD APT 1310
CHICAGO IL
60640-2543
US

IV. Provider business mailing address

1205 W SHERWIN AVE APT 704
CHICAGO IL
60626-2291
US

V. Phone/Fax

Practice location:
  • Phone: 872-366-1474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016031
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: