Healthcare Provider Details

I. General information

NPI: 1023195211
Provider Name (Legal Business Name): J.R. MOORE & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 4TH AVE N
BESSEMER AL
35020-5711
US

IV. Provider business mailing address

PO BOX 11642
BIRMINGHAM AL
35202-1642
US

V. Phone/Fax

Practice location:
  • Phone: 205-703-2020
  • Fax: 205-957-6601
Mailing address:
  • Phone: 205-703-2020
  • Fax: 205-957-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2423
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2423
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2423
License Number StateAL

VIII. Authorized Official

Name: DR. JEFFREY MOORE
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: PHD, S-LPC, NCC
Phone: 20529361657