Provider Demographics
NPI:1619171568
Name:MOORE, JUSTIN J (PHD, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:J
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 REHOBOTH DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8456
Mailing Address - Country:US
Mailing Address - Phone:501-279-9054
Mailing Address - Fax:
Practice Address - Street 1:HU BOX # 12262
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72149-0001
Practice Address - Country:US
Practice Address - Phone:501-279-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0608042101Y00000X
ARM0608007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist