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General NPI Number Information
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NPI Number | 1740775246
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Entity Type | Individual
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Provider Name | MOHAMMAD HUMAYUN SIDDIQUI LCPC
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 1801 N MILL ST STE J
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City | NAPERVILLE
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State | IL
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Zip | 60563-4869
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Country | US
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Telephone | 630-452-5409
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 N MILL ST STE J
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City | NAPERVILLE
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State | IL
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Zip | 60563-4869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.004213
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License Number State | IL
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