Individual
KELLI MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1622 7TH ST, LAS VEGAS, NM 87701-4920
(505) 310-7280
(505) 425-5408
Mailing address
1622 7TH ST, LAS VEGAS, NM 87701-4920
(505) 310-7280
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2023-0541
NM
104100000X
Social Worker
CSA0211311
NM
Other
Enumeration date
08/17/2020
Last updated
07/07/2023
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