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General NPI Number Information
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NPI Number | 1851661052
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Entity Type | Organization
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Legal Business Name | CORE COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 847 PARKCENTRE WAY SUITE 4
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City | NAMPA
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State | ID
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Zip | 83651-1792
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Country | US
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Telephone | 208-467-2673
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Fax | 208-467-4150
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Provider Business Mailing Address
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Address Line | 847 PARKCENTRE WAY SUITE 4
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City | NAMPA
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State | ID
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Zip | 83651-1792
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Country | US
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Telephone | 208-467-2673
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Fax | 208-467-4150
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Authorized Official
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Title or Position | OWNER/PROGRAM MANAGER
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Name | MR. JEFFREY RYAN MORENO
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Credential | L.C.S.W.
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Telephone | 208-570-8894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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