Provider Demographics
NPI:1497308175
Name:MIZUNO-MOORE, TAYLOR ANN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR ANN
Middle Name:
Last Name:MIZUNO-MOORE
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 1:403 SHERMAN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-6100
Mailing Address - Country:US
Mailing Address - Phone:310-433-4279
Mailing Address - Fax:
Practice Address - Street 1:67 E MADISON ST STE 1603A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3095
Practice Address - Country:US
Practice Address - Phone:847-372-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor