Individual
ELLEN CF MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC
Contact information
Practice address
18 TULIP STREET, LYNDONVILLE, VT 05851
(802) 626-8189
(704) 987-8746
Mailing address
PO BOX 1161, LYNDONVILLE, VT 05851-1161
(802) 626-8189
(704) 987-8746
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0680000355
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00029643
BCBS
VT
05
—
1007327
—
VT
01
—
1049971
CIGNA
VT
01
—
711988
MOHAWK VALLEY PLAN
VT
Enumeration date
11/07/2006
Last updated
07/08/2007
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