Provider Demographics
NPI:1164822532
Name:MOORE, JENEAN (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JENEAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:JENEAN
Other - Middle Name:
Other - Last Name:PICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34121 N US HIGHWAY 45
Mailing Address - Street 2:SUITE 221
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1768
Mailing Address - Country:US
Mailing Address - Phone:847-752-4034
Mailing Address - Fax:
Practice Address - Street 1:34121 N US HIGHWAY 45
Practice Address - Street 2:SUITE 221
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1768
Practice Address - Country:US
Practice Address - Phone:847-752-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional