Healthcare Provider Details

I. General information

NPI: 1154934594
Provider Name (Legal Business Name): MOORE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CAILLOUETT PL
LAFAYETTE LA
70501-7807
US

IV. Provider business mailing address

119 CAILLOUETT PL
LAFAYETTE LA
70501-7807
US

V. Phone/Fax

Practice location:
  • Phone: 337-366-1801
  • Fax:
Mailing address:
  • Phone: 337-366-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY MOORE
Title or Position: COUNSELOR
Credential: LPC
Phone: 337-852-4781