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NPI Code Detail

MEDICARE: JAMAL MOORE

MEDICARE: JAMAL 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
1171M00000XCase Manager/Care CoordinatorQMHSOH
2101YA0400XAddiction (Substance Use Disorder) Counselor171340OH

General Provider Information

NPI Number : 1588201461
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMAL MOORE
Provider Business Mailing Address
First Line : 316 N MICHIGAN ST
Second Line :
City : TOLEDO
State : OH
Zip : 43604-5667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2345 DORR ST
Second Line :
City : TOLEDO
State : OH
Zip : 43607-3423
Country : US
Telephone Number : 419-407-5342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2019
Last Update Date : 02/29/2024

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Directions to “ JAMAL MOORE ” Practice Location

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