Provider Demographics
NPI:1518208198
Name:MOORE, TERESA SUE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:SUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DOSS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2420
Mailing Address - Country:US
Mailing Address - Phone:573-701-1330
Mailing Address - Fax:573-701-1339
Practice Address - Street 1:530 DOSS ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2420
Practice Address - Country:US
Practice Address - Phone:573-701-1330
Practice Address - Fax:573-701-1339
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009018430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional