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NPI Code Detail

MEDICARE: GRISCILLIA MOORE LCPC

MEDICARE: GRISCILLIA MOORE 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
1101Y00000XCounselor180002896IL

General Provider Information

NPI Number : 1629394358
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRISCILLIA MOORE LCPC
Provider Business Mailing Address
First Line : 19530 KEDZIE AVE
Second Line :
City : FLOSSMOOR
State : IL
Zip : 60422-1778
Country : US
Telephone Number : 708-799-2200
Fax Number :
Provider Business Practice Location Address
First Line : 19530 KEDZIE AVE
Second Line :
City : FLOSSMOOR
State : IL
Zip : 60422-1778
Country : US
Telephone Number : 708-799-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2010
Last Update Date : 04/20/2010

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Directions to “ GRISCILLIA MOORE LCPC” Practice Location

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