MEDICARE: MS. ADRIANNE M 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	190449AN	CA
2	106H00000X	Marriage & Family Therapist	52160	CA

General Provider Information

NPI Number	:	1639380470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADRIANNE M MOORE

Provider Business Mailing Address
First Line	:	4028 DON DIABLO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4304
Country	:	US
Telephone Number	:	323-497-8150
Fax Number	:	323-643-4536

Provider Business Practice Location Address
First Line	:	3679 CRENSHAW BLVD
Second Line	:	SUITE 108
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4849
Country	:	US
Telephone Number	:	661-713-6698
Fax Number	:	323-643-4536

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	06/22/2015

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