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General NPI Number Information
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NPI Number | 1750436655
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Entity Type | Individual
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Provider Name | NIGEL CHRISTOPHER THIBODEAUX LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 708 CHURCH ST RM 258
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City | EVANSTON
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State | IL
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Zip | 60201-3875
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Country | US
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Telephone | 224-392-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 924 JUDSON AVE UNIT 3W
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City | EVANSTON
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State | IL
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Zip | 60202-4515
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Country | US
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Telephone | 224-392-1731
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149011925
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License Number State | IL
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