Provider Demographics
NPI:1598039893
Name:MOORE, CRISTINA (MSED, LMHC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSED, LMHC
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:INFANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LMHC
Mailing Address - Street 1:7032 WESTHAVEN CIR
Mailing Address - Street 2:APT 304
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7753
Mailing Address - Country:US
Mailing Address - Phone:317-439-2207
Mailing Address - Fax:
Practice Address - Street 1:5638 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5042
Practice Address - Country:US
Practice Address - Phone:888-714-1927
Practice Address - Fax:317-247-8935
Is Sole Proprietor?:No
Enumeration Date:2012-03-04
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002653A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health