Individual
MS. TAMARA RENESE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9403 MANSFIELD RD, SHREVEPORT, LA 71118-3815
(318) 861-8938
Mailing address
8115 FORK BAYOU LN, SHREVEPORT, LA 71106-5349
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
LA
Other
Enumeration date
02/09/2018
Last updated
02/09/2018
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