Healthcare Provider Details

I. General information

NPI: 1538485867
Provider Name (Legal Business Name): CARIN FALANDA MILLER MOODY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 162ND ST SUITE 211
SOUTH HOLLAND IL
60473-2471
US

IV. Provider business mailing address

900 E 162ND ST SUITE 211
SOUTH HOLLAND IL
60473-2471
US

V. Phone/Fax

Practice location:
  • Phone: 708-225-1237
  • Fax: 708-225-1338
Mailing address:
  • Phone: 708-225-1237
  • Fax: 708-225-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.004168
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: