Provider Demographics
NPI:1144729443
Name:NELSON-SEASE, NICOLE (LCPC, ATR)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NELSON-SEASE
Suffix:
Gender:F
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N MILWAUKEE AVE STE 205B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3189
Mailing Address - Country:US
Mailing Address - Phone:773-492-0913
Mailing Address - Fax:
Practice Address - Street 1:4800 N MILWAUKEE AVE STE 205B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3189
Practice Address - Country:US
Practice Address - Phone:773-492-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional