MEDICARE: ERIN L MORAN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH13965	FL

General Provider Information

NPI Number	:	1497209266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN L MORAN M.S.

Provider Business Mailing Address
First Line	:	12443 SAN JOSE BLVD
Second Line	:	SUITE 202
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8646
Country	:	US
Telephone Number	:	904-438-4399
Fax Number	:

Provider Business Practice Location Address
First Line	:	12443 SAN JOSE BLVD
Second Line	:	SUITE 202
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8646
Country	:	US
Telephone Number	:	904-438-4399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/10/2016

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