Healthcare Provider Details

I. General information

NPI: 1740094358
Provider Name (Legal Business Name): NICOLLE OSEQUEDA COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 N PINE GROVE AVE
CHICAGO IL
60614-6109
US

IV. Provider business mailing address

828 W WAVELAND AVE APT 1N
CHICAGO IL
60613-6151
US

V. Phone/Fax

Practice location:
  • Phone: 312-860-2858
  • Fax:
Mailing address:
  • Phone: 312-937-5281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASON MARTIN OSEQUEDA
Title or Position: MANAGING DIRECTOR
Credential: PHD
Phone: 312-937-5281