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General NPI Number Information
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NPI Number | 1790146595
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Entity Type | Individual
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Provider Name | JOHN PARKER MOORE L.M.H.C.,L.S.W.,M.A.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 1770 SHILOH SPRINGS RD.
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City | DAYTON
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State | OH
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Zip | 45426
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Country | US
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Telephone | 937-367-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 1770 SHILOH SPRINGS RD
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City | DAYTON
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State | OH
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Zip | 45426
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Country | US
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Telephone | 937-367-6300
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 39001063A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39001063A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33002117A
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License Number State | IN
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