Individual
JOHN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
1800 N MILFORD RD STE 100, MILFORD, MI 48381-1047
(810) 222-9847
Mailing address
1800 N MILFORD RD STE 100, MILFORD, MI 48381-1047
(248) 684-6400
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401000465
MI
103T00000X
Psychologist
6301011549
MI
103TC2200X
Clinical Child & Adolescent Psychologist
6361004249
MI
Other
Enumeration date
07/16/2014
Last updated
12/04/2024
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