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NPI Code Detail

MEDICARE: CAITLIN MOORE

MEDICARE: CAITLIN 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1972368744
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAITLIN MOORE
Provider Business Mailing Address
First Line : 1136 E SUNNYSIDE AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-3726
Country : US
Telephone Number : 661-964-9294
Fax Number :
Provider Business Practice Location Address
First Line : 11618 S STATE ST STE 1604
Second Line :
City : DRAPER
State : UT
Zip : 84020-7123
Country : US
Telephone Number : 385-202-5645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2024
Last Update Date : 02/29/2024

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Directions to “ CAITLIN MOORE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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