Healthcare Provider Details

I. General information

NPI: 1447847579
Provider Name (Legal Business Name): CENTERED PATH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 W DIVERSEY AVE # 17
CHICAGO IL
60647-8582
US

IV. Provider business mailing address

2304 N SPAULDING AVE
CHICAGO IL
60647-2520
US

V. Phone/Fax

Practice location:
  • Phone: 773-340-2517
  • Fax: 872-702-6454
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR LEYH MOORE
Title or Position: PSYCHOTHERAPIST
Credential: LCSW, CADC
Phone: 630-405-8394