MEDICARE: MRS. KIMBERLY ANN MOYER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180004373	IL

General Provider Information

NPI Number	:	1326705989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN MOYER LCPC

Provider Business Mailing Address
First Line	:	10835 S WASHTENAW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1730
Country	:	US
Telephone Number	:	773-386-4316
Fax Number	:

Provider Business Practice Location Address
First Line	:	7330 W COLLEGE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1157
Country	:	US
Telephone Number	:	708-316-1377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/18/2021

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