MEDICARE: MRS. AMBER MOORE GARTH M.S. ALC

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	C1202A	AL

General Provider Information

NPI Number	:	1831288414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER MOORE GARTH M.S. ALC

Provider Business Mailing Address
First Line	:	1615 KATHY LN SW
Second Line	:	PO BX 2239
City	:	DECATUR
State	:	AL
Zip	:	35603-1026
Country	:	US
Telephone Number	:	256-306-4091
Fax Number	:	256-306-4016

Provider Business Practice Location Address
First Line	:	1615 KATHY LN SW
Second Line	:	PO BX 2239
City	:	DECATUR
State	:	AL
Zip	:	35603-1026
Country	:	US
Telephone Number	:	256-306-4091
Fax Number	:	256-306-4016

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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