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General NPI Number Information
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NPI Number | 1235581869
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Entity Type | Individual
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Provider Name | KIMBERLY MOORE LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 3736 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-2984
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Country | US
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Telephone | 479-427-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 3736 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-2984
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Country | US
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Telephone | 479-633-7423
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Fax | 833-427-1422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1807087
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License Number State | AR
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