Individual
EZEKIEL MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1412 BENTWOOD DR, LANSING, MI 48917-2035
(517) 272-1478
Mailing address
1412 BENTWOOD DR, LANSING, MI 48917-2035
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401018236
MI
101YS0200X
School Counselor
SC0000000913456
MI
Other
Enumeration date
04/06/2020
Last updated
05/21/2020
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