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Individual

MR. DANIEL MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
103 S 19TH AVE, HATTIESBURG, MS 39401-6171
(601) 544-4641
(601) 584-4053
Mailing address
PO BOX 1030, HATTIESBURG, MS 39403-1030
(601) 544-4641
(601) 584-4053

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
33-545
MS

Other

Enumeration date
08/03/2006
Last updated
07/08/2007
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