Provider Demographics
NPI:1538485867
Name:MILLER MOODY, CARIN FALANDA (PHD)
Entity Type:Individual
Prefix:MS
First Name:CARIN
Middle Name:FALANDA
Last Name:MILLER MOODY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E 162ND ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2471
Mailing Address - Country:US
Mailing Address - Phone:708-225-1237
Mailing Address - Fax:708-225-1338
Practice Address - Street 1:900 E 162ND ST
Practice Address - Street 2:SUITE 211
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2471
Practice Address - Country:US
Practice Address - Phone:708-225-1237
Practice Address - Fax:708-225-1338
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional