Provider Demographics
NPI:1073727673
Name:MOORE, KARIN NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KARIN
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 DECLARATION DR.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-892-9772
Mailing Address - Fax:
Practice Address - Street 1:75 DECLARATION DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4914
Practice Address - Country:US
Practice Address - Phone:530-892-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS21158OtherSTATE LICENSE
CAZZZO1829ZMedicare ID - Type Unspecified