Jonathan Perry Moore, LLC
Counselor, Mental Health in Holland, MI. Individual provider (NPI-1).
NPI number1982486643
StatusActive
Last updated in NPPESOct 17, 2023
Details
- NPI
- 1982486643
- Entity type
- Individual (NPI-1)
- Name
- Jonathan Perry Moore
- Credential
- LLC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 17, 2023
- Certification date
- Oct 17, 2023
- Last updated
- Oct 17, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | 6451023316 | MI | Yes |
Practice location
170 College Ave Ste 310Holland, MI 49423-2982
Phone 616-745-6748
Mailing address
170 College Ave Ste 310Holland, MI 49423-2982
Phone 616-745-6748
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