Individual
GLEN ANTHONY MOELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1790 NATIONS DR STE 208, GURNEE, IL 60031-9176
(847) 625-9004
(847) 625-9073
Mailing address
447 PARK LN, LAKE BLUFF, IL 60044-2322
(847) 217-2460
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178.020406
IL
103TC0700X
Clinical Psychologist
101YM0800X
IL
Other
Enumeration date
11/08/2022
Last updated
07/31/2024
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