MEDICARE: KRISTIN 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
2	1041C0700X	Clinical Social Worker	8249-C	NV

General Provider Information

NPI Number	:	1558741108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MOORE

Provider Business Mailing Address
First Line	:	3732 LAKESIDE DR STE 202
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-5278
Country	:	US
Telephone Number	:	775-399-9327
Fax Number	:

Provider Business Practice Location Address
First Line	:	3732 LAKESIDE DR STE 202
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-5278
Country	:	US
Telephone Number	:	775-399-9327
Fax Number	:

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	11/20/2020

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Directions to “ KRISTIN MOORE ” Practice Location

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