MEDICARE: KARLA RAE MOORE LMHC, LSAA

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	101Y00000X	Counselor	0176501	NM

General Provider Information

NPI Number	:	1275082653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA RAE MOORE LMHC, LSAA

Provider Business Mailing Address
First Line	:	2424 MADEIRA DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4030
Country	:	US
Telephone Number	:	505-203-1467
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 MADEIRA DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4030
Country	:	US
Telephone Number	:	505-203-1467
Fax Number	:

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

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	09/27/2016

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