Provider Demographics
NPI:1558875088
Name:MOORE, MICHELE R
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 CANAL ST STE 405
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5555
Mailing Address - Country:US
Mailing Address - Phone:504-301-2888
Mailing Address - Fax:504-301-2988
Practice Address - Street 1:2714 CANAL ST STE 405
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5555
Practice Address - Country:US
Practice Address - Phone:504-301-2888
Practice Address - Fax:504-301-2988
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty