Mary Moore, LPC
Individual provider Active NPI Mental Health Counselor · Lafayette, LA
NPI 1093363871 · NPPES record last updated Aug 26, 2019
Key facts
- NPI
- 1093363871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 6779 (LA)
- Practice address
- 107 Montrose Ave
Lafayette, LA 70503-3852 - Phone
- (337) 366-1801
- NPI assigned
- Aug 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6779 | LA | MD | Speech-Language Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6779 | LA | Yes |
Addresses
Primary practice location
107 Montrose Ave
Lafayette, LA 70503-3852
Mailing address
178 Ronald Blvd
Lafayette, LA 70503-2738
Other names
- Beth Moore
Other providers in Lafayette, LA
- Moore Wellness, LLC
- Bria Moore
- Jennifer Moore
- Keyonna Chavontrel Moore
- Lacie Stafford Moore
- Matthew Moore
- Patrick Devincent Moore
- Payton Anne Moore
- Shawntel Marie Moore
- Shelley Moore
All providers in Lafayette, LA · Mental Health Counselor in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.