Healthcare Provider Details

I. General information

NPI: 1255706073
Provider Name (Legal Business Name): AYARBE CRAWFORD AND MOORE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 LAKESIDE DR SUITE 230
RENO NV
89511-8502
US

IV. Provider business mailing address

6121 LAKESIDE DR SUITE 230
RENO NV
89511-8502
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-7881
  • Fax:
Mailing address:
  • Phone: 775-786-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number129941
License Number StateNV

VIII. Authorized Official

Name: DR. BRIE MOORE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 775-786-7881