MEDICARE: MRS. JULIANA MOORE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401225725	MI

General Provider Information

NPI Number	:	1003524729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIANA MOORE LPC

Provider Business Mailing Address
First Line	:	600 HARWOOD ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3016
Country	:	US
Telephone Number	:	517-914-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 N DETTMAN RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8837
Country	:	US
Telephone Number	:	517-612-9902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	12/08/2025

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