Provider Demographics
NPI:1851339907
Name:MOORS, KATHERINE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MOORS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:204-664-5480
Mailing Address - Fax:207-664-5490
Practice Address - Street 1:32 RESORT WAY
Practice Address - Street 2:ELLSWORTH INTERNAL MEDICINE
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1717
Practice Address - Country:US
Practice Address - Phone:207-664-5480
Practice Address - Fax:207-664-5490
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER031929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME404250000OtherBCHP