Healthcare Provider Details

I. General information

NPI: 1205296449
Provider Name (Legal Business Name): LATOYA SHURREE ALMA MOORE MHP, MSW, LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 300TH ST NW
STANWOOD WA
98292-5841
US

IV. Provider business mailing address

7700 300TH ST NW
STANWOOD WA
98292-5841
US

V. Phone/Fax

Practice location:
  • Phone: 360-209-8430
  • Fax: 360-474-4024
Mailing address:
  • Phone: 360-209-8430
  • Fax: 360-474-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61416809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: