Provider Demographics
NPI:1629567052
Name:MOORE, LINDA (QMHP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 KIMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-4311
Mailing Address - Country:US
Mailing Address - Phone:217-276-7034
Mailing Address - Fax:
Practice Address - Street 1:701 MONROE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2036
Practice Address - Country:US
Practice Address - Phone:217-345-6554
Practice Address - Fax:217-655-4220
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health