Healthcare Provider Details

I. General information

NPI: 1356893804
Provider Name (Legal Business Name): CARRIE MOORE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 E BARNWOOD LN
HEBER CITY UT
84032-5445
US

IV. Provider business mailing address

2635 E BARNWOOD LN
HEBER CITY UT
84032-5445
US

V. Phone/Fax

Practice location:
  • Phone: 561-573-4848
  • Fax:
Mailing address:
  • Phone: 561-573-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13037152-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: