Individual
COLEEN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1606 HUNT DR, NORMAL, IL 61761-2192
(309) 452-0069
Mailing address
1606 HUNT DR, NORMAL, IL 61761-2192
(309) 452-0069
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180004169
IL
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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