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Individual

MRS. MARY MOORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
107 MONTROSE AVE, LAFAYETTE, LA 70503-3852
(337) 366-1801
Mailing address
178 RONALD BLVD, LAFAYETTE, LA 70503-2738

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6779
LA

Other

Enumeration date
08/26/2019
Last updated
08/26/2019
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