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General NPI Number Information
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NPI Number | 1184213332
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Entity Type | Organization
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Legal Business Name | COURTNEY MOORE MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 654 S WALKER ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2159
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Country | US
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Telephone | 812-369-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 E CRICKET KNL
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8103
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Country | US
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Telephone | 812-345-7268
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Fax |
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Authorized Official
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Title or Position | OWNER AND SOLE PROVIDER
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Name | COURTNEY L MOORE
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Credential | PMHNP-BC
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Telephone | 812-345-7268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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