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Individual

DR. DIANA MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
1323 BIA RD. 20, FORT THOMSPSON, SD 57339
(605) 245-1525
Mailing address
1323 BIA RD. 20, FORT THOMSPSON, SD 57339
(605) 245-1525

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2506
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5549010
SD
Enumeration date
11/20/2014
Last updated
11/02/2016
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