Provider Demographics
NPI:1225278542
Name:MOORE, ALAN (MED)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S JOHNSON ST
Mailing Address - Street 2:SUITE 0-C
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1658
Mailing Address - Country:US
Mailing Address - Phone:248-333-7222
Mailing Address - Fax:
Practice Address - Street 1:35 S JOHNSON ST
Practice Address - Street 2:SUITE 0-C
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1658
Practice Address - Country:US
Practice Address - Phone:248-333-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor