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General NPI Number Information
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NPI Number | 1518453521
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Entity Type | Organization
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Legal Business Name | MOORE PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 1908 WEST 21ST STREET
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-760-1535
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Fax | 800-561-2091
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Provider Business Mailing Address
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Address Line | 609 PROVIDENCE CIR
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City | CLOVIS
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State | NM
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Zip | 88101-1083
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Country | US
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Telephone | 575-760-1535
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Fax | 800-561-2091
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Authorized Official
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Title or Position | DIRECTOR/ OWNER
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Name | DR. KARLEN BROOK MOORE
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Credential | PH.D.
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Telephone | 575-760-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1511
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License Number State | NM
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