Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401007804 | MH |
N | 101YS0200X | School Counselor |
NPI | 1114231602 |
---|---|
Provider Name | Ms. Amy Lynn Moore |
First Address | Oxford, MI 48371-1250 |
Second Address | Oxford, MI 48371-6180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 06/10/2014 |