Provider Demographics
NPI:1194540716
Name:MOORE, CHRIS D (LPC-IT)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:D
Last Name:MOORE
Suffix:
Gender:
Credentials:LPC-IT
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-IT
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-0501
Mailing Address - Country:US
Mailing Address - Phone:308-398-1798
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 501
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-0501
Practice Address - Country:US
Practice Address - Phone:308-398-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8204-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional