Individual
JOHN D MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
4343 N CLARENDON AVE, #2212, CHICAGO, IL 60613-2698
(773) 704-5300
Mailing address
4343 N CLARENDON AVE, #2212, CHICAGO, IL 60613-2698
(773) 704-5300
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635350
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/19/2005
Last updated
07/08/2007
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