Individual
JERRY R MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LICDC
Contact information
Practice address
16000 HUNTERS RUN, MARYSVILLE, OH 43040-9659
(614) 582-1081
Mailing address
16000 HUNTERS RUN, MARYSVILLE, OH 43040-9659
(614) 582-1081
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1700627
OH
101YP2500X
Professional Counselor
Primary
E.1901574-SUPV
OH
Other
Enumeration date
09/24/2018
Last updated
04/08/2026
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