Individual
MR. NATHANIEL A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
200 HUBBART DAM RD, MARION, MT 59925-9708
(406) 296-4272
(406) 854-2835
Mailing address
200 HUBBART DAM RD, MARION, MT 59925-9708
(406) 296-4272
(406) 854-2835
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11780420-6006
UT
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
BBH-LAC-LIC-30140
MT
Other
Enumeration date
10/09/2020
Last updated
06/30/2021
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