MEDICARE: MOORE PSYCHOTHERAPY LLC

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	:	1871360115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	1750 WEWATTA ST UNIT 1825
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 1825
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6698
Country	:	US
Telephone Number	:	608-473-3575
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	LUCAS MOORE
Credential	:	LCSW, SUD, ICS, ACS
Telephone Number	:	608-473-3575

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	10/14/2025

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Directions to “MOORE PSYCHOTHERAPY LLC ” Practice Location

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