MEDICARE: BRANDI MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013275288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI MOORE

Provider Business Mailing Address
First Line	:	7948 W NEVSO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-5001
Country	:	US
Telephone Number	:	702-518-0376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 SAINT ROSE PKWY
Second Line	:	STE. 202
City	:	HENDERSON
State	:	NV
Zip	:	89074-7783
Country	:	US
Telephone Number	:	702-518-0376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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Directions to “ BRANDI MOORE ” Practice Location

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