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General NPI Number Information
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NPI Number | 1295107746
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Entity Type | Individual
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Provider Name | TONYA MOORE LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1010 LAKE ST STE 200
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City | OAK PARK
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State | IL
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Zip | 60301-1132
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Country | US
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Telephone | 773-457-4529
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15455
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | 773-457-4529
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35002055A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001299
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License Number State | IL
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