MEDICARE: NICOLE FORD LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178.007759	IL
2	101YP2500X	Professional Counselor	180.008984	IL

General Provider Information

NPI Number	:	1053682286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE FORD LCPC

Provider Business Mailing Address
First Line	:	1320 TOWER RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-4309
Country	:	US
Telephone Number	:	847-868-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 N ARLINGTON HEIGHTS RD STE 304E
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3978
Country	:	US
Telephone Number	:	847-670-0880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/04/2024

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