| Doctor Name: | DR. ELLEN MOORE |
| NPI Number: | 1033103809 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 2002013061 |
| Business Practice Address: | 108 E 5th St Sedalia, MO - 653014402 |
| Business Phone Number: | 6608274449 |
| Business Fax Number: | 6608276489 |
| Mailing Address: | 108 E 5th St, SEDALIA |
| State: | MO |
| Postal Code: | 653014402 |
| Phone Number: | 6608274449 |
| Fax Number: | 6608276489 |
| NPI Enumeration Date: | 09/07/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2002013061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |