MEDICARE: HIBA FATIMA MOINUDDIN MA, LPC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1376263525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIBA FATIMA MOINUDDIN MA, LPC

Provider Business Mailing Address
First Line	:	8S223 DERBY DRIVE
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540
Country	:	US
Telephone Number	:	630-699-6536
Fax Number	:

Provider Business Practice Location Address
First Line	:	2548 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2806
Country	:	US
Telephone Number	:	773-270-3795
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	01/19/2023

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