Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 180.007492 | IL |
Y | 101YP2500X | Professional Counselor | 180.007492 | IL |
NPI | 1003115460 |
---|---|
Provider Name | Erin Michelle Mooney-Simkus |
First Address | La Grange Park, IL 60526-5313 |
Second Address | La Grange Park, IL 60526-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 02/04/2020 |