Most Relevant Information
Provider Data
| NPI Number: | 1003499237 |
| Provider Name: | MADISON BLAZE MOORE |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | C.2002225-TRNE |
Most Important Dates
| Enumeration Date: | 05/05/2021 |
| Last Updated: | 05/05/2021 |
Provider Practice Location
207D COLEGATE DR
MARIETTA
OH
457502363
Practice Location Phone/Fax
| Phone: | 7403760930 |
| Fax: | 7403760933 |
Provider Mailing Location
207D COLEGATE DR
MARIETTA
OH
457502363
Provider Mailing Phone/Fax
| Phone: | 7403760930 |
| Fax: | 7403760933 |