MEDICARE: TAMMY LYNN 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1962771394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMMY LYNN MOORE

Provider Business Mailing Address
First Line	:	1200 W 5TH AVE STE 102D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W 5TH AVE STE 102D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2503
Country	:	US
Telephone Number	:	614-398-1180
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	TAMMY LYNN MOORE
Credential	:
Telephone Number	:	614-398-1180

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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