Healthcare Provider Details

I. General information

NPI: 1518453521
Provider Name (Legal Business Name): MOORE PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 WEST 21ST STREET
CLOVIS NM
88101
US

IV. Provider business mailing address

609 PROVIDENCE CIR
CLOVIS NM
88101-1083
US

V. Phone/Fax

Practice location:
  • Phone: 575-760-1535
  • Fax: 800-561-2091
Mailing address:
  • Phone: 575-760-1535
  • Fax: 800-561-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1511
License Number StateNM

VIII. Authorized Official

Name: DR. KARLEN BROOK MOORE
Title or Position: DIRECTOR/ OWNER
Credential: PH.D.
Phone: 575-760-1535