Provider Demographics
NPI:1871922120
Name:MOORE, EILEEN MARY (LPCC)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARY
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9599 SUMMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:KY
Mailing Address - Zip Code:41007-9055
Mailing Address - Country:US
Mailing Address - Phone:859-635-0500
Mailing Address - Fax:859-635-0504
Practice Address - Street 1:2816 BLUEGRASS DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1577
Practice Address - Country:US
Practice Address - Phone:859-442-8500
Practice Address - Fax:859-442-8555
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY0274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional