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Individual

STACEY L MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6600
(414) 454-6450
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6600
(414) 454-6450

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3571
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40995500
WI
Enumeration date
11/30/2007
Last updated
11/30/2007
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