Individual
MR. THOMAS L MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
310 E. LAKE ST., TOM MOORE, MCCALL, ID 83638
(208) 634-4404
(208) 634-1855
Mailing address
PO BOX 4630, MCCALL, ID 83638
(208) 634-4404
(208) 634-1855
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC 391
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCPC 391
STATE LICENSSE
ID
Enumeration date
01/16/2008
Last updated
01/16/2008
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