MEDICARE: TRINIDAD MORIN 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	101YP2500X	Professional Counselor	178011905	IL
2	101YP2500X	Professional Counselor	180.016977	IL

General Provider Information

NPI Number	:	1154916310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINIDAD MORIN LCPC

Provider Business Mailing Address
First Line	:	4071 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2117
Country	:	US
Telephone Number	:	773-217-8571
Fax Number	:

Provider Business Practice Location Address
First Line	:	4071 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2117
Country	:	US
Telephone Number	:	773-217-8571
Fax Number	:

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	10/09/2025

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