Individual
CECILY RENEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-MHSP
Contact information
Practice address
15 BENT TWIG DR, JACKSON, TN 38305-6477
(731) 394-4555
Mailing address
15 BENT TWIG DR, JACKSON, TN 38305-6477
(731) 394-4555
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
4522
TN
222Q00000X
Developmental Therapist
—
FL
Other
Enumeration date
12/19/2014
Last updated
10/18/2023
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