Provider Demographics
NPI:1538779863
Name:MOORE THERAPEUTIC AND CONSULTING SERVICES
Entity type:Organization
Organization Name:MOORE THERAPEUTIC AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:TYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW-C
Authorized Official - Phone:571-247-8039
Mailing Address - Street 1:1600 MARYLAND AVE NE APT 257
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7662
Mailing Address - Country:US
Mailing Address - Phone:571-247-8039
Mailing Address - Fax:
Practice Address - Street 1:1600 MARYLAND AVE NE APT 257
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7662
Practice Address - Country:US
Practice Address - Phone:571-247-8039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty