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Organization

NICOLLE OSEQUEDA COUNSELING LLC

Active
Parent organization
NICOLLE OSEQUEDA COUNSELING LLC
Other names
Lincoln Park Therapy Group
Organization subpart
Yes

Provider details

NPI number
Legal business name
NICOLLE OSEQUEDA COUNSELING LLC
Authorized official
JASON MARTIN OSEQUEDA PHD (MANAGING DIRECTOR)
(312) 937-5281
Entity
Organization

Contact information

Practice address
2755 N PINE GROVE AVE, CHICAGO, IL 60614-6109
(312) 860-2858
Mailing address
828 W WAVELAND AVE APT 1N, CHICAGO, IL 60613-6151
(312) 937-5281

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
106H00000X
Marriage & Family Therapist
251S00000X
Community/Behavioral Health Agency
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Enumeration date
02/04/2025
Last updated
02/04/2025
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