Healthcare Provider Details

I. General information

NPI: 1265154223
Provider Name (Legal Business Name): MOORE COUNSELING & MEDIATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22639 EUCLID AVE
EUCLID OH
44117-1622
US

IV. Provider business mailing address

1909 E 123RD ST
CLEVELAND OH
44106-1940
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax:
Mailing address:
  • Phone: 443-453-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN MICHELLE PERKEY
Title or Position: INTAKE SPECIALIST
Credential: CASE MANAGER/ INTAKE
Phone: 216-404-1900