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General NPI Number Information
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NPI Number | 1619171568
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Entity Type | Individual
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Provider Name | JUSTIN J MOORE PHD, LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | HU BOX # 12262
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City | SEARCY
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State | AR
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Zip | 72149-0001
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Country | US
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Telephone | 501-279-4347
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 REHOBOTH DR
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City | SEARCY
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State | AR
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Zip | 72143-8456
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Country | US
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Telephone | 501-279-9054
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P0608042
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M0608007
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License Number State | AR
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