Individual
MR. PHILLIP MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LPC-IT, SAC-IT
Contact information
Practice address
11414 W PARK PL STE 202, MILWAUKEE, WI 53224-3500
(920) 204-6668
Mailing address
11414 W PARK PL STE 202, MILWAUKEE, WI 53224-3500
(920) 204-6668
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20136-130
WI
101YP2500X
Professional Counselor
Primary
7610-226
WI
Other
Enumeration date
03/18/2024
Last updated
03/18/2024
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