Provider Demographics
NPI:1821511163
Name:MOORE, KEVIN T
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:T
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 LAKE FOREST BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6202
Mailing Address - Country:US
Mailing Address - Phone:504-323-3440
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD STE 700
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6202
Practice Address - Country:US
Practice Address - Phone:504-323-3440
Practice Address - Fax:866-294-2148
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health