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General NPI Number Information
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NPI Number | 1366456048
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Entity Type | Individual
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Provider Name | TIFFANY ANNETTE MOORE MA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 5 W PEARCE BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-1415
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Country | US
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Telephone | 636-344-6572
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Fax |
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Provider Business Mailing Address
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Address Line | 312 PLEASANT MEADOWS DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-2672
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Country | US
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Telephone | 636-344-6572
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Fax |
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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 | 2003019174
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License Number State | MO
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