MEDICARE: ALYZA 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	101YP2500X	Professional Counselor	C.2305000	OH

General Provider Information

NPI Number	:	1386348456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYZA MOORE

Provider Business Mailing Address
First Line	:	330 W 4TH ST APT 12
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2653
Country	:	US
Telephone Number	:	512-879-8213
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 W 4TH ST APT 12
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-2653
Country	:	US
Telephone Number	:	512-879-8213
Fax Number	:

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

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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Directions to “ ALYZA MOORE ” Practice Location

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