Individual
DR. ANDREW B MOUTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
10640 W 165TH STREET, ORLAND PARK, IL 60467-5653
(708) 364-0261
(708) 364-6019
Mailing address
10640 W 165TH STREET, ORLAND PARK, IL 60467-5653
(708) 364-0261
(708) 364-6019
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071004325
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071004325
STATE LICENSE
IL
Enumeration date
05/30/2006
Last updated
05/13/2009
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