MEDICARE: JULIA MOORE LLMSW, CMHP, QMHP

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	171M00000X	Case Manager/Care Coordinator	6801102683	MI
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1881162592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA MOORE LLMSW, CMHP, QMHP

Provider Business Mailing Address
First Line	:	5625 ELIZABETH LAKE RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-2756
Country	:	US
Telephone Number	:	586-785-7112
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 ELIZABETH LAKE RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-2756
Country	:	US
Telephone Number	:	586-785-7112
Fax Number	:

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

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	02/14/2023

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