Provider Demographics
NPI:1720243843
Name:MOODY BIBLE INSTITUTE
Entity Type:Organization
Organization Name:MOODY BIBLE INSTITUTE
Other - Org Name:MOODY THEOLOGICAL SEMINARY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKJOLDAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-329-2870
Mailing Address - Street 1:820 N LASALLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3284
Mailing Address - Country:US
Mailing Address - Phone:312-329-2870
Mailing Address - Fax:312-329-4419
Practice Address - Street 1:820 N LASALLE BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3284
Practice Address - Country:US
Practice Address - Phone:312-329-2870
Practice Address - Fax:312-329-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty