Provider Information for 1003470303
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LISA BETH MOORE LPC-IT
Sex: Female
NPI: 1003470303
Last Updated: 2019-04-23
Certification Date:
Certification Date:
Details
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| NPI | 1003470303 | ||||||||
| Enumeration Date | 2019-04-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 1298 WOODRUFF, WI 54568-1298 United States Phone: 262-364-4968 | Fax: | ||||||||
| Primary Practice Address | 101 W BROADWAY FL 2 WAUKESHA, WI 53186-4833 United States Phone: 262-547-5567 | Fax: | ||||||||
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