Individual
GARY L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
500 W FORT ST, BOISE VAMC, BOISE, ID 83702-4598
(208) 422-1360
Mailing address
PO BOX 33, NORTH FORK, ID 83466-0033
(208) 865-2100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 27136
ID
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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