Jerry R. Moore, LPC, LICDC
NPI 1558845743ActiveIndividual· Counselor, Professional· Marysville, OH
Counselor, Professional (LPC, LICDC) with Oh Independent Medical Group LLC, practicing in Marysville, Ohio. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1558845743 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LPC, LICDC |
| Sole proprietor | Yes |
| NPI issued | Sep 24, 2018 |
| Last updated in NPPES | Apr 8, 2026 |
| Certified by provider | Apr 8, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | E.1901574-SUPV | OH |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (OH) |
|---|
Education and affiliations
| Graduation year | 2014 |
|---|---|
| Medicare specialty | Mental Health Counselor |
| Telehealth | Offers telehealth |
Medical group
- Oh Independent Medical Group LLCTallmadge, OH · 144 clinicians
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