Provider Demographics
NPI:1205030566
Name:MOORE, JOSEPH HAROLD (LPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HAROLD
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 GOLFVIEW LN
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8924
Mailing Address - Country:US
Mailing Address - Phone:231-546-2242
Mailing Address - Fax:
Practice Address - Street 1:800 LIVINGSTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8351
Practice Address - Country:US
Practice Address - Phone:989-732-7558
Practice Address - Fax:989-732-8672
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI64010068431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical