Healthcare Provider Details

I. General information

NPI: 1871908491
Provider Name (Legal Business Name): CANDICE NICOLE MORAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HUMPHREYS 131
WARRENSBURG MO
64093
US

IV. Provider business mailing address

HUMPHREYS 131 UCM COUNSELING CENTER
WARRENSBURG MO
64093
US

V. Phone/Fax

Practice location:
  • Phone: 660-543-4060
  • Fax:
Mailing address:
  • Phone: 660-543-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2014017940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: