MEDICARE: KARMELITA 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	:	1295358430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARMELITA MOORE

Provider Business Mailing Address
First Line	:	2342 N 2ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3227
Country	:	US
Telephone Number	:	414-248-6358
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 N 76TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-3508
Country	:	US
Telephone Number	:	414-248-6358
Fax Number	:

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

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	05/22/2020

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Directions to “ KARMELITA MOORE ” Practice Location

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