Provider Demographics
NPI:1568132462
Name:MOORE, JEFFRY DEAN (MS, LPC, LAMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:DEAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MS, LPC, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7186
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72124-7186
Mailing Address - Country:US
Mailing Address - Phone:501-502-0317
Mailing Address - Fax:
Practice Address - Street 1:10201 W MARKHAM ST STE 324
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2195
Practice Address - Country:US
Practice Address - Phone:501-502-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF2108002106H00000X
ARP2403003101YP2500X
ARA2108017101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional