Individual
MR. JEFFREY JAY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LLPC
Contact information
Practice address
901 EASTERN AVE NE, GRAND RAPIDS, MI 49503-1201
(616) 224-7617
Mailing address
1950 MEADOWFIELD DR NE, GRAND RAPIDS, MI 49505-4805
(616) 551-2328
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401011917
MI
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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