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General NPI Number Information
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NPI Number | 1336718360
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Entity Type | Individual
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Provider Name | COURTNEY LYNN MOORE SUDPT
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 3430 E HIGHWAY 101 STE 3
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City | PORT ANGELES
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State | WA
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Zip | 98362-9069
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Country | US
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Telephone | 360-452-4062
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Fax | 360-452-4189
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Provider Business Mailing Address
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Address Line | PO BOX 478
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City | PORT ANGELES
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State | WA
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Zip | 98362-0072
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Country | US
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Telephone | 360-452-4062
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Fax | 360-452-4189
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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 | CO61189828
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License Number State | WA
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