Provider Demographics
NPI:1508248402
Name:MOORE, MICHE'L (MS MFT)
Entity Type:Individual
Prefix:
First Name:MICHE'L
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13309 WATERTOWN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2217
Mailing Address - Country:US
Mailing Address - Phone:262-649-3297
Mailing Address - Fax:
Practice Address - Street 1:13309 WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2217
Practice Address - Country:US
Practice Address - Phone:262-649-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI445-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist