Individual
DUSTIN BURSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 ADDISON AVE W STE 1000, TWIN FALLS, ID 83301-5853
(208) 736-5048
Mailing address
776 N POINTE DR, TWIN FALLS, ID 83301-3285
(360) 751-4313
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-9658
ID
171M00000X
Case Manager/Care Coordinator
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Other
Enumeration date
01/18/2023
Last updated
07/19/2023
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