Provider Demographics
NPI:1285865618
Name:MOSS, STEFANIE TAYLOR (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:TAYLOR
Last Name:MOSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 NEWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1923
Mailing Address - Country:US
Mailing Address - Phone:847-362-6919
Mailing Address - Fax:847-247-2220
Practice Address - Street 1:1641 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:847-362-6919
Practice Address - Fax:847-247-2220
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional