1770744252 NPI number — MS. JOAN FAYE MOORE L.P.C.-S, B.S.W.

Table of content: MS. JOAN FAYE MOORE L.P.C.-S, B.S.W. (NPI 1770744252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770744252 NPI number — MS. JOAN FAYE MOORE L.P.C.-S, B.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
JOAN
Provider Middle Name:
FAYE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.-S, B.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770744252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 531
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76431-0531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-389-0860
Provider Business Mailing Address Fax Number:
940-644-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 COUNTY ROAD 1749
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76431-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-389-0860
Provider Business Practice Location Address Fax Number:
940-644-5741
Provider Enumeration Date:
06/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  17306 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 165307301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".