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NPI Code Detail

MEDICARE: MR. NICHOLAS ANTHONY CORNE MOD, MA, LCPC

MEDICARE: MR. NICHOLAS ANTHONY CORNE MOD, MA, 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
1101YM0800XMental Health CounselorC.1700658OH

General Provider Information

NPI Number : 1831616234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICHOLAS ANTHONY CORNE MOD, MA, LCPC
Provider Business Mailing Address
First Line : 5315 N CLARK ST # 225
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2290
Country : US
Telephone Number : 872-205-6425
Fax Number :
Provider Business Practice Location Address
First Line : 5153 N CLARK ST STE 307
Second Line :
City : CHICAGO
State : IL
Zip : 60640-6850
Country : US
Telephone Number : 872-205-6425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2017
Last Update Date : 04/29/2026

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