Individual
KEITH MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2316 N COLE RD STE A, BOISE, ID 83704-7365
(208) 323-2273
Mailing address
1516 1/2 N 7TH ST, BOISE, ID 83702-3733
(208) 651-0203
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-6900
ID
Other
Enumeration date
06/21/2018
Last updated
06/21/2018
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