Provider Demographics
NPI:1437392768
Name:MOORE, GARY L (LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPC
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Mailing Address - Street 1:2120 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2692
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:480-804-0083
Practice Address - Street 1:3260 N HAYDEN RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6649
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:480-804-0083
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2013-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ11516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC- 11516OtherAZ LPC