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NPI Code Detail

MEDICARE: CHARISSE ALEXANDRIA MOORE LMSW

MEDICARE: CHARISSE ALEXANDRIA MOORE LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLMSW-18317AZ

General Provider Information

NPI Number : 1073242145
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARISSE ALEXANDRIA MOORE LMSW
Provider Business Mailing Address
First Line : 24250 N 23RD AVE UNIT 1027
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-1910
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1095 E INDIAN SCHOOL RD STE 700
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4846
Country : US
Telephone Number : 623-225-7591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2022
Last Update Date : 06/06/2022

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