Individual
KEVIN LOWERY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC, LADC
Contact information
Practice address
4463 261ST AVE NW, ISANTI, MN 55040-4351
(176) 327-6028
Mailing address
4463 261ST AVE NW, ISANTI, MN 55040-4351
(176) 327-6028
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303673
MN
101YP2500X
Professional Counselor
Primary
01764
MN
Other
Enumeration date
06/07/2022
Last updated
06/07/2022
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