MEDICARE: CHARLYN ANN MOORE LMHC, NCC

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	MH21958	FL

General Provider Information

NPI Number	:	1538840251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLYN ANN MOORE LMHC, NCC

Provider Business Mailing Address
First Line	:	5045 E HINSON AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-8872
Country	:	US
Telephone Number	:	863-557-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	5045 E HINSON AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-8872
Country	:	US
Telephone Number	:	863-557-3944
Fax Number	:

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

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/31/2023

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