Provider Demographics
NPI:1669973541
Name:HORA, NATHAN HORA ALLEN (MA, LCPC)
Entity type:Individual
Prefix:
First Name:NATHAN HORA
Middle Name:ALLEN
Last Name:HORA
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121016
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-5098
Mailing Address - Country:US
Mailing Address - Phone:616-446-3977
Mailing Address - Fax:
Practice Address - Street 1:2416 W AUGUSTA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4639
Practice Address - Country:US
Practice Address - Phone:616-446-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009050101YP2500X
180.009050101YP2500X
IL180.009050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty