Provider Demographics
NPI:1588943831
Name:MOORE, LAURA ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 N GLOSTER ST STE F
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1239
Mailing Address - Country:US
Mailing Address - Phone:662-694-0260
Mailing Address - Fax:
Practice Address - Street 1:1014 N GLOSTER ST STE F
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1239
Practice Address - Country:US
Practice Address - Phone:662-694-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional