Healthcare Provider Details

I. General information

NPI: 1629373584
Provider Name (Legal Business Name): LINDA ANN BUTLER-MOORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA ANN MOORE LMFT

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YOUREE DR
SHREVEPORT LA
71101-5117
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-0804
  • Fax: 318-425-9030
Mailing address:
  • Phone: 318-742-3408
  • Fax: 318-841-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2275
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: