Individual
JOL WARREN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
98 LOGAN ST, BELEN, NM 87002-6014
(505) 864-4850
Mailing address
98 LOGAN ST, BELEN, NM 87002-6014
(505) 864-4850
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0128121
NM
Other
Enumeration date
02/03/2010
Last updated
02/03/2010
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