Healthcare Provider Details

I. General information

NPI: 1164475984
Provider Name (Legal Business Name): ROBERT MOYLAN LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W OGDEN AVE
NAPERVILLE IL
60540-9600
US

IV. Provider business mailing address

1750 W OGDEN AVE
NAPERVILLE IL
60540-9600
US

V. Phone/Fax

Practice location:
  • Phone: 630-717-2662
  • Fax: 815-768-2279
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180005037
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180005037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: