Healthcare Provider Details

I. General information

NPI: 1972413235
Provider Name (Legal Business Name): J.A. MOORE COUNSELING & CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W INSTITUTE PL STE 210
CHICAGO IL
60610-3196
US

IV. Provider business mailing address

213 W INSTITUTE PL STE 210
CHICAGO IL
60610-3196
US

V. Phone/Fax

Practice location:
  • Phone: 847-396-9681
  • Fax:
Mailing address:
  • Phone: 847-396-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN A. MOORE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 847-396-9681