Individual
JANICE RENEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1304 CHINOOK LN, PUEBLO, CO 81001-1851
(719) 545-2746
(719) 584-0110
Mailing address
41 MONTEBELLO RD STE 200, PUEBLO, CO 81001-1366
(719) 545-2746
(719) 542-9638
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACA.0007115
CO
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/27/2017
Last updated
01/08/2018
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