Provider Demographics
NPI:1679115414
Name:JENNIFER L MOORE, LMFT, LLC
Entity type:Organization
Organization Name:JENNIFER L MOORE, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:864-398-9418
Mailing Address - Street 1:601 N BELAIR SQ STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4322
Mailing Address - Country:US
Mailing Address - Phone:706-619-1286
Mailing Address - Fax:803-792-4055
Practice Address - Street 1:601 N BELAIR SQ STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4322
Practice Address - Country:US
Practice Address - Phone:706-619-1286
Practice Address - Fax:803-792-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health