Michelle Glynise Moore, EARLY INTERVENTION P

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149027689 Issued in IL

Practice address

PO Box 658
Blue Island, IL 60406

Phone

(708) 698-0714

NPI assigned

May 19, 2008

Last updated

May 11, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Michelle Glynise Moore Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Holistic Counseling & Developmental Services LLC

  • Mental Health Counselor
  • Lombard, IL
  • NPI 1548151186

  Early Intervention Provider Agency

  NPD Authorized official
• MGM Therapy & Behavioral Treatment Corporation

  • Early Intervention Provider Agency
  • Calumet Park, IL
  • NPI 1215480207
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1760649628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "246 E JANATA BLVD STE 111",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601485317",
            "telephone_number": "708-698-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "60406",
            "telephone_number": "708-698-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MICHELLE",
        "middle_name": "GLYNISE",
        "name_prefix": "Mrs.",
        "credential": "EARLY INTERVENTION P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150107720",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149027689",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "MOORE",
            "middle_name": "GLYNISE",
            "prefix": "MRS.",
            "credential": "EARLY INTERVENTION P",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Simona Milner, NURSE
• Danielle Mitchell
• Monarch Home Care, Inc.
• Monarch Medical Supplies, Inc.
• Moore Professional Childcare and Learning Center (Litehouse Rehabilitation, LLC)
• Dionne C. Morgan
• Kendrah Mone Mosley
• MSMC Home Care LLC (MetroSouth Home Care)
• MSMC Hospice LLC (MetroSouth Hospice)
• MSMC Investors LLC

• Clinical Social Worker in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.