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General NPI Number Information
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NPI Number | 1669265567
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Entity Type | Individual
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Provider Name | SPENCER MOUSTIS
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 29 S WEBSTER ST STE 230
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City | NAPERVILLE
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State | IL
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Zip | 60540-5356
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Country | US
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Telephone | 415-585-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 525 STATION BLVD APT 519
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City | AURORA
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State | IL
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Zip | 60504-4444
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Country | US
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Telephone | 815-768-5576
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.020396
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License Number State | IL
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