Provider Demographics
NPI:1205374899
Name:HALL-MOREAUX, KYESHA
Entity Type:Individual
Prefix:
First Name:KYESHA
Middle Name:
Last Name:HALL-MOREAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 LE OAKS DR
Mailing Address - Street 2:311
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7821
Mailing Address - Country:US
Mailing Address - Phone:318-302-9460
Mailing Address - Fax:
Practice Address - Street 1:2940 LE OAKS DR
Practice Address - Street 2:311
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7821
Practice Address - Country:US
Practice Address - Phone:318-302-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst