Organization
SOURCE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNTON MOORE MA LPC CACII (COUNSELPR)
(970) 729-0862
Entity
Organization
Contact information
Practice address
177 SHERMAN STREET #101, BALANCE NATURAL MEDICINE, RIDGWAY, CO 81432
(970) 729-0862
Mailing address
PO BOX 685, RIDGWAY, CO 81432-0685
(970) 729-0862
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC0011756
CO
Other
Enumeration date
12/08/2014
Last updated
01/15/2016
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