MEDICARE: MR. CHRISTOPHER TREVOR 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	101YS0200X	School Counselor	0000086266	NV

General Provider Information

NPI Number	:	1669804779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER TREVOR MOORE

Provider Business Mailing Address
First Line	:	6260 W BROOKS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4357
Country	:	US
Telephone Number	:	702-521-9653
Fax Number	:

Provider Business Practice Location Address
First Line	:	6260 W BROOKS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4357
Country	:	US
Telephone Number	:	702-521-9653
Fax Number	:

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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