Individual
MIKAYLA C MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
330 E BELTLINE AVE NE STE 320, GRAND RAPIDS, MI 49506-1267
(616) 745-8640
Mailing address
6845 TERRA COTTA DR SE, CALEDONIA, MI 49316-8005
(616) 745-8640
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009854
MI
Other
Enumeration date
11/23/2023
Last updated
11/23/2023
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