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General NPI Number Information
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NPI Number | 1508923152
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Entity Type | Individual
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Provider Name | HENRIETTA LOUISE MOORE M.ED,LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 612 CARPENTER RD SE
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City | OLYMPIA
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State | WA
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Zip | 98503-1383
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Country | US
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Telephone | 360-951-7540
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Fax |
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Provider Business Mailing Address
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Address Line | 5244 DEERFIELD PARK CT NE
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City | OLYMPIA
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State | WA
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Zip | 98516-2131
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Country | US
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Telephone | 360-491-7212
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00001032
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License Number State | WA
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