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1265442131
GARY L MOORE
BOISE, ID
NPI
1265442131
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ID LCSW 27136)
Enumeration Date
2006-08-09
Last Update Date
2007-07-08
Business Address
-- GARY L MOORE LCSW
500 W FORT ST BOISE VAMC
BOISE, ID 83702-4598
Phone number: 208-422-1360
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Mailing Address
-- GARY L MOORE LCSW
PO BOX 33
NORTH FORK, ID 83466-0033
Phone number: 208-865-2100
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