Individual
LORI JEAN MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
3971 FM 1249 E, KILGORE, TX 75662-8468
(903) 917-1798
Mailing address
3971 FM 1249 E LOT 12, KILGORE, TX 75662-8469
(903) 917-1798
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16764
TX
Other
Enumeration date
07/02/2024
Last updated
07/02/2024
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