Provider Demographics
NPI:1790146595
Name:MOORE, JOHN PARKER (LMHC,LSW,MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PARKER
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMHC,LSW,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 SHILOH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426
Mailing Address - Country:US
Mailing Address - Phone:937-367-6300
Mailing Address - Fax:
Practice Address - Street 1:1770 SHILOH SPRINGS RD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426
Practice Address - Country:US
Practice Address - Phone:937-367-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001063A101YA0400X, 101YM0800X
IN33002117A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker