| Doctor Name: | ELLEN CF MOORE |
| NPI Number: | 1881763779 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCMHC |
| License Number: | 0680000355 |
| Business Practice Address: | 18 Tulip Street Lyndonville, VT - 05851 |
| Business Phone Number: | 8026268189 |
| Business Fax Number: | 7049878746 |
| Mailing Address: | Po Box 1161, LYNDONVILLE |
| State: | VT |
| Postal Code: | 058511161 |
| Phone Number: | 8026268189 |
| Fax Number: | 7049878746 |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0680000355 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |