Provider Demographics
NPI:1518950450
Name:MOORE, TERRANCE R (LCSW)
Entity type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 S 132ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2573
Mailing Address - Country:US
Mailing Address - Phone:402-334-1122
Mailing Address - Fax:402-334-8171
Practice Address - Street 1:2255 S 132ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2573
Practice Address - Country:US
Practice Address - Phone:402-334-1122
Practice Address - Fax:402-334-8171
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE311041C0700X
NE241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076860626Medicaid
NE47076860626Medicaid