Provider Demographics
NPI:1215229026
Name:MOORE, JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4863 N NEVADA AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3951
Mailing Address - Country:US
Mailing Address - Phone:719-203-8205
Mailing Address - Fax:
Practice Address - Street 1:4863 N NEVADA AVE STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-255-8001
Practice Address - Fax:719-255-8044
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0004390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical