Most Relevant Information
Provider Data
| NPI Number: | 1003178559 |
| Provider Name: | COURTNEY MOORE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/11/2012 |
| Last Updated: | 06/11/2012 |
Provider Practice Location
2055 GARRETT WAY
STE 2
POCATELLO
ID
832015100
Practice Location Phone/Fax
| Phone: | 2082337832 |
| Fax: |
Provider Mailing Location
PO BOX 4908
POCATELLO
ID
832054908
Provider Mailing Phone/Fax
| Phone: | 2082361600 |
| Fax: |