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General NPI Number Information
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NPI Number | 1053077966
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Entity Type | Individual
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Provider Name | DAVID MOORE MA, LMHC
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Gender | Male
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 857 SUNRISE BLVD
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City | WATERLOO
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State | IA
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Zip | 50701-4949
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Country | US
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Telephone | 319-800-5564
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Fax |
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Provider Business Mailing Address
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Address Line | 104 BROOKERIDGE DR # 132
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City | WATERLOO
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State | IA
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Zip | 50702-5702
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Country | US
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Telephone | 319-214-3194
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Fax | 319-774-0026
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 093761
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License Number State | IA
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