MEDICARE: NICOLE 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

General Provider Information

NPI Number	:	1235761073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MOORE

Provider Business Mailing Address
First Line	:	3127 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3134
Country	:	US
Telephone Number	:	213-819-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3133
Country	:	US
Telephone Number	:	702-850-8700
Fax Number	:

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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Directions to “ NICOLE MOORE ” Practice Location

Language	Start Address	Practice Location

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