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General NPI Number Information
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NPI Number | 1740174887
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Entity Type | Individual
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Provider Name | THAYNE DAVID MOORE MS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 220 W 15TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-6763
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Country | US
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Telephone | 308-224-0596
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Fax | 308-224-0596
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Provider Business Mailing Address
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Address Line | 2814 W 37TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-0420
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Country | US
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Telephone | 308-455-7646
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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 | 14450
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License Number State | NE
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