MEDICARE: KIMBERLY MOORE LPC, LMFT

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	101YP2500X	Professional Counselor	P1807087	AR

General Provider Information

NPI Number	:	1235581869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MOORE LPC, LMFT

Provider Business Mailing Address
First Line	:	3736 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2984
Country	:	US
Telephone Number	:	479-633-7423
Fax Number	:	833-427-1422

Provider Business Practice Location Address
First Line	:	3736 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2984
Country	:	US
Telephone Number	:	479-427-8333
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	08/19/2024

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