Most Relevant Information
Provider Data
| NPI Number: | 1003470303 |
| Provider Name: | LISA BETH MOORE LPC-IT |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 3523-266 |
Most Important Dates
| Enumeration Date: | 04/23/2019 |
| Last Updated: | 04/23/2019 |
Provider Practice Location
101 W BROADWAY FL 2
WAUKESHA
WI
531864833
Practice Location Phone/Fax
| Phone: | 2625475567 |
| Fax: |
Provider Mailing Location
PO BOX 1298
WOODRUFF
WI
545681298
Provider Mailing Phone/Fax
| Phone: | 2623644968 |
| Fax: |