MEDICARE: BILLIE MOORE

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
1	101YM0800X	Mental Health Counselor
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235582875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLIE MOORE

Provider Business Mailing Address
First Line	:	1155 E TWAIN AVE STE 108-5042
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-4208
Country	:	US
Telephone Number	:	510-755-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	2755 E DESERT INN RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3690
Country	:	US
Telephone Number	:	702-490-9009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	04/30/2025

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Directions to “ BILLIE MOORE ” Practice Location

Language	Start Address	Practice Location

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