MEDICARE: LUCAS E. 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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	8309-123	WI

General Provider Information

NPI Number	:	1477837607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS E. MOORE

Provider Business Mailing Address
First Line	:	1750 WEWATTA ST UNIT 1826
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6698
Country	:	US
Telephone Number	:	608-473-3575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 WEWATTA ST UNIT 1826
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6698
Country	:	US
Telephone Number	:	608-473-3575
Fax Number	:

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/14/2025

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Directions to “ LUCAS E. MOORE ” Practice Location

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