Doctor Name: | ANTHONY BRYANT MORAN |
NPI Number: | 1093113557 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 178010379 |
Business Practice Address: | 1016 S Madison St Suite A Du Quoin, IL - 628322442 |
Business Phone Number: | 6185424357 |
Business Fax Number: | 6185423442 |
Mailing Address: | 301 W Elm St Apt 3, CARBONDALE |
State: | IL |
Postal Code: | 629012765 |
Phone Number: | 6185424357 |
Fax Number: | 6185423442 |
NPI Enumeration Date: | 12/16/2014 |
NPI Last Update Date: | 12/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 178010379 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | 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 |