Provider Demographics
NPI:1275903528
Name:MOORE, KRISTY LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DALLAS STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:KY
Mailing Address - Zip Code:41171-8275
Mailing Address - Country:US
Mailing Address - Phone:606-738-4579
Mailing Address - Fax:606-738-4579
Practice Address - Street 1:32 DALLAS STEPHENS RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:KY
Practice Address - Zip Code:41171-8275
Practice Address - Country:US
Practice Address - Phone:606-738-4579
Practice Address - Fax:606-738-4579
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical