Provider Demographics
NPI:1548985880
Name:TIVITT-MOORE, PATSY MORGAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATSY
Middle Name:MORGAN
Last Name:TIVITT-MOORE
Suffix:
Gender:F
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:PO BOX 4237
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755-4237
Mailing Address - Country:US
Mailing Address - Phone:270-230-1777
Mailing Address - Fax:
Practice Address - Street 1:346 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1428
Practice Address - Country:US
Practice Address - Phone:270-230-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical