Healthcare Provider Details

I. General information

NPI: 1275998627
Provider Name (Legal Business Name): MOORE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 PENNSYLVANIA AVE SUITE 200
TYRONE PA
16686-1600
US

IV. Provider business mailing address

1222 PENNSYLVANIA AVE SUITE 200
TYRONE PA
16686-1600
US

V. Phone/Fax

Practice location:
  • Phone: 814-684-5588
  • Fax: 814-684-5130
Mailing address:
  • Phone: 814-684-5588
  • Fax: 814-684-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number077027
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number077027
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number077027
License Number StatePA

VIII. Authorized Official

Name: DEBORAH ANN MOORE
Title or Position: OWNER
Credential: BA
Phone: 814-684-5588