Individual
LISA BETH MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
101 W BROADWAY FL 2, WAUKESHA, WI 53186-4833
(262) 547-5567
Mailing address
PO BOX 1298, WOODRUFF, WI 54568-1298
(262) 364-4968
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3523-266
WI
Other
Enumeration date
04/23/2019
Last updated
04/23/2019
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