Provider Demographics
NPI:1053731711
Name:MOORE, LAURA (LPCC)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:MOORE-SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9058
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:401 LEWIS HARGETT CIR STE 220
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3565
Practice Address - Country:US
Practice Address - Phone:859-971-2585
Practice Address - Fax:859-971-7594
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID