Healthcare Provider Details

I. General information

NPI: 1003115460
Provider Name (Legal Business Name): ERIN MICHELLE MOONEY-SIMKUS LCPC. ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 10/31/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 ROBINHOOD LN
LA GRANGE PARK IL
60526-5313
US

IV. Provider business mailing address

1224 ROBINHOOD LN
LA GRANGE PARK IL
60526-5313
US

V. Phone/Fax

Practice location:
  • Phone: 773-919-3746
  • Fax:
Mailing address:
  • Phone: 773-919-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.007492
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number08-230
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007492
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: