Healthcare Provider Details

I. General information

NPI: 1093453532
Provider Name (Legal Business Name): THOMAS PHILLIP MOORE II LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5095 MIRIAM LN
PARKER CO
80134-5179
US

IV. Provider business mailing address

400 S FARRELL DR
PALM SPRINGS CA
92262-7964
US

V. Phone/Fax

Practice location:
  • Phone: 530-718-6074
  • Fax:
Mailing address:
  • Phone: 760-620-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC21613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: