Provider Demographics
NPI:1114076858
Name:MOORE, CLEOLA (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CLEOLA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 RUE DE VALEUR
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3839
Mailing Address - Country:US
Mailing Address - Phone:225-266-6899
Mailing Address - Fax:225-775-3594
Practice Address - Street 1:2900 WESTFORK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0010
Practice Address - Country:US
Practice Address - Phone:225-295-5625
Practice Address - Fax:225-775-3594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1209101YP2500X
LA966106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist