Doctor Name: | MR. THOMAS L MOORE |
NPI Number: | 1457537896 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | LCPC 391 |
Business Practice Address: | 310 E. Lake St. Tom Moore Mccall, ID - 83638 |
Business Phone Number: | 2086344404 |
Business Fax Number: | 2086341855 |
Mailing Address: | Po Box 4630, MCCALL |
State: | ID |
Postal Code: | 83638 |
Phone Number: | 2086344404 |
Fax Number: | 2086341855 |
NPI Enumeration Date: | 01/16/2008 |
NPI Last Update Date: | 01/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LCPC 391 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |