MEDICARE: TASHIA MOORE LCSW

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	104100000X	Social Worker	64999	TX
2	1041C0700X	Clinical Social Worker	LW61386001	WA
3	1041C0700X	Clinical Social Worker	64999	TX
4	1041C0700X	Clinical Social Worker	29354	MD
5	1041C0700X	Clinical Social Worker	114138	CA

General Provider Information

NPI Number	:	1205495173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHIA MOORE LCSW

Provider Business Mailing Address
First Line	:	539 W COMMERCE ST STE 298
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	254-251-1237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N WATSON RD STE 177
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6223
Country	:	US
Telephone Number	:	682-238-0151
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	10/19/2023

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