Provider Demographics
NPI:1730513995
Name:MOORE, PATRICIA LOUISE (MACP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 REZANOF DR E
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6416
Mailing Address - Country:US
Mailing Address - Phone:907-481-2400
Mailing Address - Fax:907-481-2419
Practice Address - Street 1:717 REZANOF DR E
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6416
Practice Address - Country:US
Practice Address - Phone:907-481-2400
Practice Address - Fax:907-481-2419
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH2237Medicaid