Healthcare Provider Details

I. General information

NPI: 1902904634
Provider Name (Legal Business Name): LAURIE ANN MOYER LMHC, LCAC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 PRO-MED LN
CARMEL IN
46032-5317
US

IV. Provider business mailing address

703 PRO-MED LN
CARMEL IN
46032-5317
US

V. Phone/Fax

Practice location:
  • Phone: 317-843-9922
  • Fax: 317-581-3918
Mailing address:
  • Phone: 317-843-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: