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General NPI Number Information
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NPI Number | 1679699151
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Entity Type | Individual
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Provider Name | JOHN THOMAS MOORE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 498 NW 18TH ST
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City | RICHMOND
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State | IN
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Zip | 47374-2851
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Country | US
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Telephone | 765-935-9317
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Fax |
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Provider Business Mailing Address
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Address Line | 507 RUBYTHROAT LN
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City | CLAYTON
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State | OH
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Zip | 45315-8742
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Country | US
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Telephone | 937-832-0572
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20010430A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5174
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License Number State | OH
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