Provider Demographics
NPI:1407299142
Name:MOOR, ERIC SHANE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SHANE
Last Name:MOOR
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VREELAND ST
Mailing Address - Street 2:PO BOX 205
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MI
Mailing Address - Zip Code:49262-8728
Mailing Address - Country:US
Mailing Address - Phone:517-398-0426
Mailing Address - Fax:
Practice Address - Street 1:30 N HOWELL ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1621
Practice Address - Country:US
Practice Address - Phone:517-783-4250
Practice Address - Fax:517-783-4164
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional