Provider Demographics
NPI:1972789535
Name:MOORE, ANN JOLENE (LCPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:JOLENE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:JOLENE
Other - Last Name:BARRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4696 W OVERLAND RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2845
Mailing Address - Country:US
Mailing Address - Phone:208-841-3581
Mailing Address - Fax:208-906-8572
Practice Address - Street 1:4696 W OVERLAND RD
Practice Address - Street 2:SUITE 118
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2845
Practice Address - Country:US
Practice Address - Phone:208-841-3581
Practice Address - Fax:208-906-8572
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3938101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health