Provider Demographics
NPI:1982857207
Name:MOORE, ALAN W (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:#11
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-351-5795
Mailing Address - Fax:859-294-0802
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:#11
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-351-5795
Practice Address - Fax:859-294-0802
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional