Healthcare Provider Details

I. General information

NPI: 1285551838
Provider Name (Legal Business Name): TORI MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 BROAD AVE
MEMPHIS TN
38112-2903
US

IV. Provider business mailing address

66 MONROE AVE APT 303
MEMPHIS TN
38103-2443
US

V. Phone/Fax

Practice location:
  • Phone: 901-260-8500
  • Fax:
Mailing address:
  • Phone: 501-909-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: