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General NPI Number Information
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NPI Number | 1841411964
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Entity Type | Individual
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Provider Name | TERRY EILEEN MOORE LPC
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 910 PIERREMONT ROAD SUITE 410
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City | SHREVEPORT
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State | LA
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Zip | 71106
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Country | US
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Telephone | 318-865-8616
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Fax | 318-865-8617
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Provider Business Mailing Address
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Address Line | 915 ELMWOOD STREET
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City | SHREVEPORT
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State | LA
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Zip | 71104
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Country | US
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Telephone | 318-453-5774
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Fax | 318-865-8617
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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 | 3247
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License Number State | LA
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