Derek Raymond Moore, CADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178017617 Issued in IL

Practice address

800 Roosevelt Rd Ste 206
Glen Ellyn, IL 60137-5839

Phone

(630) 423-5935

NPI assigned

Oct 3, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1851876031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8020 W 87TH ST",
            "city": "HICKORY HILLS",
            "state": "IL",
            "postal_code": "604571189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD STE 206",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375839",
            "telephone_number": "630-423-5935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8020 W 87th St",
            "address_purpose": "LOCATION",
            "city": "Hickory Hills",
            "state": "IL",
            "postal_code": "604571189",
            "country_code": "US",
            "telephone_number": "708-995-3851 x3865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DEREK",
        "middle_name": "RAYMOND",
        "credential": "CADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-03",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "34385",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178017617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Peter Moeller, LCSW
• Mahmuda Sultana Mohsin, M.D.
• Alexandra Molina
• Katharine Moon Raess
• Moon Wellness LLC
• Terence Moore
• Kelsie Jane Moosmann, OTR/L
• Jacqueline Moran, MD
• Julie M Moreschi, MS RDN LDN
• David Morris, MD

• Mental Health Counselor in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; 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.