Provider Demographics
NPI:1053731711
Name:MOORE, LAURA (LPCC)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:MOORE-SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:29 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1139
Mailing Address - Country:US
Mailing Address - Phone:606-375-3384
Mailing Address - Fax:
Practice Address - Street 1:901 US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9188
Practice Address - Country:US
Practice Address - Phone:606-584-7055
Practice Address - Fax:866-533-4929
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID