Provider Demographics
NPI:1578070553
Name:MOORE, KATHLEEN FAYE (LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FAYE
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 1:665 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3941
Mailing Address - Country:US
Mailing Address - Phone:412-600-0863
Mailing Address - Fax:724-801-8751
Practice Address - Street 1:665 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3941
Practice Address - Country:US
Practice Address - Phone:412-600-0863
Practice Address - Fax:724-801-8751
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003122101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC003122OtherLICENSE