Individual
MARY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
200 TURWILL LN, KALAMAZOO, MI 49006-4277
(269) 344-4413
Mailing address
2115 BROADWAY AVE, KALAMAZOO, MI 49008-1614
(269) 344-4413
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301007034
MI
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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