Individual
STEPHANIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CADC, CTP
Contact information
Practice address
1646 305TH ST, TAMA, IA 52339-9698
(641) 484-9482
(641) 484-9477
Mailing address
1646 305TH ST, TAMA, IA 52339-9698
(641) 484-9482
(641) 484-9477
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19016
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0074575
—
IA
Enumeration date
11/20/2019
Last updated
02/02/2022
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