Provider Demographics
NPI:1417460916
Name:MOORE, JESSICA MICHELLE (MS, NCC, LMHC)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, LMHC
Mailing Address - Street 1:4409 SONOMA CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4260
Mailing Address - Country:US
Mailing Address - Phone:850-969-6604
Mailing Address - Fax:
Practice Address - Street 1:4409 SONOMA CIR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4260
Practice Address - Country:US
Practice Address - Phone:520-366-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0015855101YM0800X
GA0015551101YM0800X
FLMH17958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health