| Doctor Name: | MS. JERRI DENISE MOORE |
| NPI Number: | 1265745673 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 2009012907 |
| Business Practice Address: | 820 Park Dr Ste Genevieve, MO - 636701566 |
| Business Phone Number: | 5738837407 |
| Business Fax Number: | 5738837537 |
| Mailing Address: | 402 S Silver Springs Rd, CAPE GIRARDEAU |
| State: | MO |
| Postal Code: | 637037536 |
| Phone Number: | 5733396130 |
| Fax Number: | 5736514345 |
| NPI Enumeration Date: | 07/15/2010 |
| NPI Last Update Date: | 12/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2009012907 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |