Organization
LAVENDER MOON SELF ILLUMINATING COUNSELING SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR QUINN (OWNER/LCPC)
(708) 504-2528
Entity
Organization
Contact information
Practice address
1400 W RANDOLPH ST UNIT 1002, CHICAGO, IL 60607-1433
(708) 918-4456
Mailing address
11430 LAKEBROOK CT, ORLAND PARK, IL 60467-8506
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/02/2024
Last updated
04/17/2025
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