Individual
TIMOTHY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
450 W 14TH ST, CHICAGO HEIGHTS, IL 60411-2463
(708) 503-9670
Mailing address
450 W 14TH ST, CHICAGO HEIGHTS, IL 60411-2463
(708) 503-9670
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180001082
IL
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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