Healthcare Provider Details

I. General information

NPI: 1649254863
Provider Name (Legal Business Name): MARIA L MORES PSY.D., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 29TH ST
CHEYENNE WY
82001-2760
US

IV. Provider business mailing address

510 W 29TH ST
CHEYENNE WY
82001-2760
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-9362
  • Fax: 307-637-6852
Mailing address:
  • Phone: 307-632-9362
  • Fax: 307-637-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number337
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number367
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: