Individual
MR. MARK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
540 E 1ST ST, WACONIA, MN 55387
(952) 442-4437
(952) 442-3084
Mailing address
9533 ROOSEVELT DR, CHANHASSEN, MN 55317-4612
(952) 250-0602
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/06/2014
Last updated
08/09/2018
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