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Deactivated NPI 1063654192 Deactivated / Inactive NPI Female Practitioner

Mary G Moore , LCPC

Counselor • Normal, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Mary Moore has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 06, 2009
NPI Deactivation Date January 25, 2023
Total Practice Duration ~14 Years of Practice (2009 – 2023)

Professional Overview & Biography Verified Profile Summary

Mary Moore, LCPC was a registered Counselor practicing in Normal, IL. Throughout an active medical career spanning 14 years, Mary Moore provided care at the practice location at 103 WILLIAM DR until profile deactivation on 2023-01-25.

Practice Location & Contact Primary Location

Practice Address

103 William Dr

Normal, IL 617611862

Telephone 3094521473
Fax 3098624597

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor in Normal, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.4 Yrs
Regional Practice Density
7 Specialists

Practicing in Normal, IL (3897 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor Primary Specialty

NUCC Taxonomy Code: 101Y00000X

State License IL 180000847

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 25, 2023

Record deactivated on January 25, 2023

NPI Profile Active April 06, 2009

NPI status registered as active in NPPES database

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Updated Practice Location April 06, 2009

Registered at 103 WILLIAM DR, NORMAL, IL 617611862 (Tel: 3094521473)

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Updated Business Mailing Address April 06, 2009

Registered at 103 WILLIAM DR, NORMAL, IL 617611862 (Tel: 3094521473)

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Provider Name / Credentials Updated April 06, 2009

Recorded as MARY MOORE, L.C.P.C.

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 06, 2009

Counselor (License #180000847 in IL)

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Initial NPI Registration & Enumeration April 06, 2009

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1063654192
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 06, 2009
Last Update: April 06, 2009
Deactivation Date: January 25, 2023

Mailing Address

103 William Dr

Normal, IL 617611862

Phone: 3094521473

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.