Provider Demographics
NPI:1144900101
Name:MOORE, KELLY MARIE (ART-BC, LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:ART-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1582
Mailing Address - Country:US
Mailing Address - Phone:412-904-5990
Mailing Address - Fax:
Practice Address - Street 1:5743 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1582
Practice Address - Country:US
Practice Address - Phone:412-904-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional