Healthcare Provider Details

I. General information

NPI: 1205292125
Provider Name (Legal Business Name): TASJANIQUE MOORE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 07/19/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10040 I 10 SERVICE RD STE B
NEW ORLEANS LA
70127-2701
US

IV. Provider business mailing address

5527 CITRUS BLVD Y282
ELMWOOD LA
70123
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-5220
  • Fax:
Mailing address:
  • Phone: 504-617-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13356
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number13356
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: