Individual
MS. KELLY MICHELLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
301 FISHER STREET, KEESLER AFB, MS 39534
(228) 376-0385
Mailing address
301 FISHER STREET, KEESLER AFB MENTAL HEALTH CLINIC, KEESLER AFB, MS 39534
(228) 376-0385
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
C8385
MS
104100000X
Social Worker
M8385
MS
1041C0700X
Clinical Social Worker
Primary
C8385
MS
Other
Enumeration date
05/16/2018
Last updated
02/17/2023
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