MEDICARE: NICOLLE T. MOORE IMFT

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	106H00000X	Marriage & Family Therapist	F.0500043	OH

General Provider Information

NPI Number	:	1366696866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLLE T. MOORE IMFT

Provider Business Mailing Address
First Line	:	4629 AICHOLTZ RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 AICHOLTZ RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1447
Country	:	US
Telephone Number	:	513-752-1555
Fax Number	:

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	01/13/2026

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