Healthcare Provider Details

I. General information

NPI: 1770404683
Provider Name (Legal Business Name): CASSANDRA MOORE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 STRAWBERRY RIVER ROAD 8816
DUCHESNE UT
84021
US

IV. Provider business mailing address

HC63 BOX 8816
DUCHESNE UT
84021
US

V. Phone/Fax

Practice location:
  • Phone: 801-889-0872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14186415-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: