Healthcare Provider Details

I. General information

NPI: 1851019608
Provider Name (Legal Business Name): IMAAN AHMED LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10031 W ROOSEVELT RD STE 210
WESTCHESTER IL
60154-2669
US

IV. Provider business mailing address

10031 W ROOSEVELT RD STE 210
WESTCHESTER IL
60154-2669
US

V. Phone/Fax

Practice location:
  • Phone: 630-290-8735
  • Fax:
Mailing address:
  • Phone: 630-290-8735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180017879
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23703
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: