Provider Demographics
NPI:1982395471
Name:MOORE, MARY LOUELLA (ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUELLA
Last Name:MOORE
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-9325
Mailing Address - Country:US
Mailing Address - Phone:530-415-4580
Mailing Address - Fax:
Practice Address - Street 1:2800 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5961
Practice Address - Country:US
Practice Address - Phone:530-534-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health