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General NPI Number Information
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NPI Number | 1912096173
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Entity Type | Individual
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Provider Name | INGRID MOORE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 3732 LAKESIDE DR STE 200
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City | RENO
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State | NV
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Zip | 89509-4519
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Country | US
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Telephone | 775-376-1235
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Fax | 775-376-1235
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Provider Business Mailing Address
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Address Line | 3067 BRAMBLE DR
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City | RENO
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State | NV
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Zip | 89509-6902
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Country | US
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Telephone | 775-376-1235
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Fax | 775-376-1235
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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 | PY0162
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License Number State | NV
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