Provider Demographics
NPI:1598060766
Name:MOORE, KATHERINE RENEE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:KATHERINE
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S MAIN ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5987
Mailing Address - Country:US
Mailing Address - Phone:724-283-9436
Mailing Address - Fax:
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5987
Practice Address - Country:US
Practice Address - Phone:724-283-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2019-12-11
Deactivation Date:2019-11-19
Deactivation Code:
Reactivation Date:2019-12-11
Provider Licenses
StateLicense IDTaxonomies
PAPC005768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional