Individual
MR. MITCHELL JAT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
923 N BROADWAY, ROCHESTER, MN 55906-6843
(507) 281-6223
Mailing address
614 WOODDALE CT NW, ROCHESTER, MN 55901-2472
(507) 282-6075
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300769
MN
Other
Enumeration date
01/11/2007
Last updated
07/08/2007
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