Individual
ELISE R MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLP
Contact information
Practice address
128 N WARREN AVE STE B, BIG RAPIDS, MI 49307-3207
(164) 580-6926
(616) 458-8129
Mailing address
18185 WILSON DR, BIG RAPIDS, MI 49307-9729
(231) 408-2358
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301011828
MI
Other
Enumeration date
05/20/2009
Last updated
09/12/2022
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