=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770406266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA RENEE MOORE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2026
-----------------------------------------------------
Last Update Date | 08/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 BEACON PKWY W STE 202
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-401-8363
-----------------------------------------------------
Fax | 205-536-9156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 170771
-----------------------------------------------------
City | TARRANT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35217-0771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-578-2033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | ALC06035
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------