Provider Demographics
NPI:1366991259
Name:MOORE, MARION
Entity type:Individual
Prefix:MRS
First Name:MARION
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 KINGSTON RD
Mailing Address - Street 2:APT. # 1001
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3466
Mailing Address - Country:US
Mailing Address - Phone:318-402-9957
Mailing Address - Fax:318-716-1234
Practice Address - Street 1:9045 KINGSTON RD
Practice Address - Street 2:APT. # 1001
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3466
Practice Address - Country:US
Practice Address - Phone:318-402-9957
Practice Address - Fax:318-716-1234
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor