Provider Demographics
NPI:1225635063
Name:MOORE, BRIONNA
Entity Type:Individual
Prefix:
First Name:BRIONNA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 W ELIZABETH ST APT 211
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4549
Mailing Address - Country:US
Mailing Address - Phone:562-522-1648
Mailing Address - Fax:
Practice Address - Street 1:706 S COLLEGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-9860
Practice Address - Country:US
Practice Address - Phone:970-875-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)