1982737011 NPI number — DR. C L MOORE PHD LP LMFT

Table of content: DR. C L MOORE PHD LP LMFT (NPI 1982737011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982737011 NPI number — DR. C L MOORE PHD LP LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
C
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD LP LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
C
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD LP LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982737011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 NORTH CHARLES ST
Provider Second Line Business Mailing Address:
STE 236
Provider Business Mailing Address City Name:
N ST PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-771-4766
Provider Business Mailing Address Fax Number:
651-771-4784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 NORTH CHARLES ST
Provider Second Line Business Practice Location Address:
STE 236
Provider Business Practice Location Address City Name:
N ST PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-771-4766
Provider Business Practice Location Address Fax Number:
651-771-4784
Provider Enumeration Date:
03/14/2007

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: 103T00000X , with the licence number:  LP2246 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PY00000625 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 440 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 1 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 104097 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39036800 . This is a "WI MEDICAID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 212T8PE . This is a "BC BS BT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6049644 . This is a "STATE OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP19293 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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