Provider Demographics
NPI:1265322093
Name:ANTHONY-MOORE, JOSEY RAE (CRM,CADC-R)
Entity type:Individual
Prefix:
First Name:JOSEY
Middle Name:RAE
Last Name:ANTHONY-MOORE
Suffix:
Gender:F
Credentials:CRM,CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 SE DIVISION ST STE 11104SE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6400
Mailing Address - Country:US
Mailing Address - Phone:971-703-4623
Mailing Address - Fax:
Practice Address - Street 1:21440 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2024
Practice Address - Country:US
Practice Address - Phone:971-703-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-CRM-4052175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist