| Kristen N Moore Lmsw Pllc | |
|
736 Reef Dr Canton MI 48187-0106 | |
| (248) 702-4302 | |
| Not Available |
| Full Name | Kristen N Moore Lmsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 736 Reef Dr, Canton, Michigan |
| Authorized Official Name and Position | Kristen Nicole Moore (LMSW) |
| Authorized Official Contact | 7343348311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kristen N Moore Lmsw Pllc 736 Reef Dr Canton MI 48187-0106 Ph: (734) 304-0771 | Kristen N Moore Lmsw Pllc 736 Reef Dr Canton MI 48187-0106 Ph: (248) 702-4302 |
| NPI Number | 1508643511 |
|---|---|
| Provider Enumeration Date | 09/12/2023 |
| Last Update Date | 02/22/2024 |
| Certification Date | 02/22/2024 |
| Medicare PECOS PAC ID | 2668818063 |
|---|---|
| Medicare Enrollment ID | O20240307002902 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508643511 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kristen N Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619345238 PECOS PAC ID: 5799039756 Enrollment ID: I20181112000843 |
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