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General NPI Number Information
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NPI Number | 1124510979
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Entity Type | Organization
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Legal Business Name | VICTORIA MOORE THERAPY PLLC
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 438
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City | CHICAGO
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State | IL
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Zip | 60604-3416
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Country | US
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Telephone | 312-809-0652
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Fax |
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Provider Business Mailing Address
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Address Line | 53 W JACKSON BLVD STE 438
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City | CHICAGO
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State | IL
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Zip | 60604-3416
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Country | US
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Telephone | 312-809-0652
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TE YOU MOORE
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Credential | LCPC, CGP, AGPA-F
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Telephone | 312-809-0652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 180.011449
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License Number State | IL
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