Provider Demographics
NPI:1700937190
Name:SEASONS CHANGE, PLLC
Entity Type:Organization
Organization Name:SEASONS CHANGE, PLLC
Other - Org Name:SHAUNA KAY MOORE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:317-902-8471
Mailing Address - Street 1:3205 US 421 N
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-7428
Mailing Address - Country:US
Mailing Address - Phone:317-902-8471
Mailing Address - Fax:
Practice Address - Street 1:207 W FRONT ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5821
Practice Address - Country:US
Practice Address - Phone:910-814-8009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2015-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1645251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty