Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jerry R Moore, LPC, LICDC

Individual provider Professional Counselor · NPI 1558845743

Jerry R Moore, LPC, LICDC is a Mental Health Counselor in Marysville, Ohio. Qualified in 2014, 12 years ago. Practices as a sole proprietor. Licensed in Ohio.

Years since qualifying
12
Licensed in
OH
In the registry since
2018
What do these letters mean?
LPC — Licensed Professional Counselor
A licensed mental health counsellor.

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Practice location Address checks out

16000 Hunters Run
Marysville, OH 43040-9659
Phone: (614) 582-1081
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence E.1901574-SUPV (OH)

Record details

NPI number1558845743
Entity typeIndividual (Type 1)
GenderMale
Credentials LPC , LICDC
Sole proprietorYes
NPI enumeratedSeptember 24, 2018
Last updated in NPPESApril 8, 2026
Certification dateApril 8, 2026
Mailing address16000 Hunters Run, Marysville, OH 43040-9659

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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