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Individual

JERROLD MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMHC

Contact information

Practice address
990 ILLINOIS ST, PLYMOUTH, IN 46563-3622
(574) 936-9646
(574) 935-4773
Mailing address
850 N HARRISON ST, WARSAW, IN 46580-3163
(574) 267-7169
(574) 935-4773

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001287A
IN

Other

Enumeration date
01/21/2014
Last updated
01/21/2014
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