MEDICARE: MS. CELETRA BEATRICE MOSES

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1801397088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CELETRA BEATRICE MOSES

Provider Business Mailing Address
First Line	:	245 W ROOSEVELT RD STE 103
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-4819
Country	:	US
Telephone Number	:	312-882-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	9111 TRINITY DR
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-1668
Country	:	US
Telephone Number	:	888-308-3728
Fax Number	:

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

Provider Enumeration Date	:	02/23/2018
Last Update Date	:	02/26/2025

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