Provider Demographics
NPI:1114577541
Name:RECEIVING MOORE PSYCHOTHERAPY PC
Entity Type:Organization
Organization Name:RECEIVING MOORE PSYCHOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-416-1304
Mailing Address - Street 1:6315 AYLESWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1276
Mailing Address - Country:US
Mailing Address - Phone:402-416-1304
Mailing Address - Fax:402-347-0909
Practice Address - Street 1:6315 AYLESWORTH AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1276
Practice Address - Country:US
Practice Address - Phone:402-416-1304
Practice Address - Fax:402-347-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty