Individual
BRADLEY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24 WEATHERFORD SQ, JACKSON, TN 38305-2202
(731) 660-6760
Mailing address
24 WEATHERFORD SQ, JACKSON, TN 38305-2202
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NONE
—
Enumeration date
04/25/2022
Last updated
04/25/2022
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