Organization
LONGBOARDERS LLC.
Active
Organization
LONGBOARDERS LLC.
Active
Other names
Mizuno- Moore Psychotherapy & Consulting- Tower 22
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR ANN MOORE LCPC (FOUNDER, DIRECTOR)
(847) 372-1593
Entity
Organization
Contact information
Practice address
67 E MADISON ST STE 1603A, CHICAGO, IL 60603-3095
(847) 372-1593
Mailing address
67 E MADISON ST STE 1603A, CHICAGO, IL 60603-3095
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497308175
NPI TYPE 1
IL
Enumeration date
08/02/2023
Last updated
08/06/2025
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