|Taxonomy Code||Specialty Code||Provider Type|
|1041C0700X||80||Licensed Clinical Social Worker|
|LBN Legal business name||MOORE COUNSELING & MEDIATION SERVICES, INC.|
|Authorized official||BRIAN MOORE - (VICE PRESIDENT OF OPERATIONS)|
|Organization subpart 1||No|
|Last updated||05/15/2012 - About 4 years ago|
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