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General NPI Number Information
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NPI Number | 1255078119
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Entity Type | Organization
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Legal Business Name | NEW MOON COUNSELING PLLC
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 1740 N MAPLEWOOD AVE APT 211
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City | CHICAGO
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State | IL
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Zip | 60647-5281
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Country | US
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Telephone | 847-612-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 N MAPLEWOOD AVE APT 211
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City | CHICAGO
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State | IL
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Zip | 60647-5281
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Country | US
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Telephone | 847-612-9477
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | GABRIELLE L WOLK-PHILLIPS
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Credential | PSYD
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Telephone | 847-612-9477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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