MEDICARE: THOMAS JOSEPH NIMROD

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	101YP1600X	Pastoral Counselor
2	101YP2500X	Professional Counselor	180016031

General Provider Information

NPI Number	:	1134745417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOSEPH NIMROD

Provider Business Mailing Address
First Line	:	1205 W SHERWIN AVE APT 704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-2291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 N SHERIDAN RD APT 1310
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2543
Country	:	US
Telephone Number	:	872-366-1474
Fax Number	:

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

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	12/16/2025

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