Individual
MYRA MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
402 CHURCH ST STE 2, SUMMERSVILLE, WV 26651-1495
(304) 256-4555
(304) 256-4715
Mailing address
PO BOX 211, MOUNT NEBO, WV 26679-0211
(304) 719-9701
(304) 872-4453
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
22070
WV
103TS0200X
School Psychologist
22070
WV
Other
Enumeration date
10/15/2012
Last updated
08/15/2023
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