=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275998627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOORE COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2015
-----------------------------------------------------
Last Update Date | 12/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 PENNSYLVANIA AVE SUITE 200
-----------------------------------------------------
City | TYRONE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16686-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-684-5588
-----------------------------------------------------
Fax | 814-684-5130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 PENNSYLVANIA AVE SUITE 200
-----------------------------------------------------
City | TYRONE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16686-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-684-5588
-----------------------------------------------------
Fax | 814-684-5130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBORAH ANN MOORE
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 814-684-5588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 077027
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 077027
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 077027
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------