Individual
MARISSA OPAL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
815 S ASH ST, NEVADA, MO 64772-3222
(417) 667-8352
(417) 667-9216
Mailing address
27561 E LOGAN RD, WALKER, MO 64790-8612
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2017044142
MO
Other
Enumeration date
01/15/2018
Last updated
09/30/2020
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