Healthcare Provider Details

I. General information

NPI: 1548151186
Provider Name (Legal Business Name): HOLISTIC COUNSELING & DEVELOPMENTAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 E JANATA BLVD STE 111
LOMBARD IL
60148-5317
US

IV. Provider business mailing address

246 E JANATA BLVD STE 111
LOMBARD IL
60148-5317
US

V. Phone/Fax

Practice location:
  • Phone: 708-901-0003
  • Fax:
Mailing address:
  • Phone: 708-698-0714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MICHELLE GLYNISE MOORE
Title or Position: CLINICAL SOCIAL WORKER
Credential: DT LMSW LCSW
Phone: 708-698-0714