1396221735 NPI number — THE TRAUMA MASTERMINDS

Table of content: MRS. ALISON NICOLE MOORE QMHS (NPI 1487168217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396221735 NPI number — THE TRAUMA MASTERMINDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE TRAUMA MASTERMINDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396221735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 HILL RD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKERINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43147-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-604-3475
Provider Business Mailing Address Fax Number:
206-338-2103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 HILL RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-604-3475
Provider Business Practice Location Address Fax Number:
206-338-2103
Provider Enumeration Date:
07/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MINOGUCHI
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
614-604-3475

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I-0028045 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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