Provider Demographics
NPI:1063651230
Name:MOORE, EDITH M (LAC)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:M
Last Name:MOORE
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Gender:F
Credentials:LAC
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Mailing Address - Street 1:1300 E. MISSOURI AVE. SUITE A-100
Mailing Address - Street 2:FAMILY RESOURCE & RECOVERY CENTER
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014
Mailing Address - Country:US
Mailing Address - Phone:602-265-3099
Mailing Address - Fax:602-265-3123
Practice Address - Street 1:1300 E. MISSOURI AVE. SUITE A-100
Practice Address - Street 2:FAMILY RESOURCE & RECOVERY CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-265-3099
Practice Address - Fax:602-265-3123
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2010-08-05
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Provider Licenses
StateLicense IDTaxonomies
AZLAC 13130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional