Healthcare Provider Details

I. General information

NPI: 1588855472
Provider Name (Legal Business Name): BRIE ASHLEY MOORE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 S MCCARRAN BLVD SUITE D1-28
RENO NV
89509-6102
US

IV. Provider business mailing address

6490 S MCCARRAN BLVD SUITE D1-28
RENO NV
89509-6102
US

V. Phone/Fax

Practice location:
  • Phone: 775-846-2995
  • Fax:
Mailing address:
  • Phone: 775-846-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: