Provider Demographics
NPI:1528441144
Name:MOORE, JANICE (LPC,LISAC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC,LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15857 E PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3628
Mailing Address - Country:US
Mailing Address - Phone:480-495-1413
Mailing Address - Fax:
Practice Address - Street 1:15857 E PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3628
Practice Address - Country:US
Practice Address - Phone:480-495-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10272101YA0400X
AZLPC-11792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)