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NPI Code Detail

MEDICARE: INGRID MOORE PH.D.

MEDICARE: INGRID MOORE PH.D.
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
1103TC0700XClinical PsychologistPY0162NV

General Provider Information

NPI Number : 1912096173
Entity Type Code : Individual
Provider Name (Legal Business Name) : INGRID MOORE PH.D.
Provider Business Mailing Address
First Line : 3067 BRAMBLE DR
Second Line :
City : RENO
State : NV
Zip : 89509-6902
Country : US
Telephone Number : 775-376-1235
Fax Number : 775-376-1235
Provider Business Practice Location Address
First Line : 3732 LAKESIDE DR STE 200
Second Line :
City : RENO
State : NV
Zip : 89509-4519
Country : US
Telephone Number : 775-376-1235
Fax Number : 775-376-1235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 01/25/2026

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