MR. TIM MOODY (NPI# 1740630516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740630516 |
| Entity Type | Individual |
| Full Name | MR. TIM MOODY |
| Credential | LPC NBCC |
| Practice Address |
840 Kirkwood Dr Apt 8 Springfield IL 62712-6853 |
| Practice Telephone | 2175209877 |
| Mailing Telephone | 2175209877 |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
178.011258 | IL | Behavioral Health & Social Service Providers |
| Street Address |
840 KIRKWOOD DR APT 8 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62712-6853 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881943678 | Roland Folse | Surgery | 2 Virginia Lane, Springfield, IL 62712 | 2012-09-07 |
| 1548351703 | Sarah Megan Toland | Speech-Language Pathologist | 3700 Castle Hill Blvd, Springfield, IL 62712 | 2006-09-27 |
| 1558463760 | Beverly J Matthews | Psychologist | 3517 Carnoustie Dr, Springfield, IL 62712 | 2006-09-01 |
| 1164593018 | Mark Alan Rose | Dentist | 6301 Wind Tree Rd, Springfield, IL 62712-3738 | 2006-11-13 |
| 1457392227 | Matticks Medcon LLC | Durable Medical Equipment & Medical Supplies | 6309 Wind Tree Rd, Springfield, IL 62712-3738 | 2006-06-10 |
| 1265602452 | Roderick L Matticks | Family Medicine | 6309 Wind Tree Rd, Springfield, IL 62712-3738 | 2008-03-04 |
| 1134321581 | Donna Maria Matticks | Developmental Therapist | 6309 Wind Tree Rd, Springfield, IL 62712-3738 | 2007-06-05 |
| 1134595531 | Karen Brown | Behavioral Analyst | 15 E Hazel Dell Ln, Springfield, IL 62712-4210 | 2015-08-19 |
| 1255834651 | Denise Kay Demoulin | Speech-Language Pathologist | 15 E Hazel Dell Ln, Springfield, IL 62712-4210 | 2018-03-12 |
| 1275089302 | Victoria Branda | Behavioral Analyst | 15 E Hazel Dell Ln, Springfield, IL 62712-4210 | 2016-08-29 |
| Find all providers in zip 62712 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
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| 1972114411 | Doris Osiimwe Johnson | Counselor | 52 Elaine Cir # 52, Springfield, MA 01109-1205 | 2020-08-10 |
| 1003426610 | Jy Counseling LLC | Counselor | 6054 Forrest Hollow Ln, Springfield, VA 22152-1428 | 2020-08-07 |
| 1912526674 | Amy Christine Russell | Counselor | 317 30th St Apt 304d, Springfield, OR 97478-7619 | 2020-04-13 |
| 1588299184 | Julie Patricia Slover | Counselor | 3331 S Parkview Ave, Springfield, MO 65804-4755 | 2020-03-04 |
| 1356986319 | Three Dirty Birds LLC | Counselor | 805 Lorraine Dr, Springfield, PA 19064-1004 | 2019-11-14 |
| 1992348916 | Tiffany Looney | Counselor | 1705 Centennial Blvd Ste 1, Springfield, OR 97477-3320 | 2019-10-22 |
| 1588206346 | Carrie Stormzand | Counselor | 4546 S Quail Creek Ave, Springfield, MO 65810-1678 | 2019-10-14 |
| 1366084295 | Betty Jean | Counselor | 673 Morris Ave, Springfield, NJ 07081-1512 | 2019-10-11 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62712 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.