Provider Demographics
NPI:1316194053
Name:MOORE, COURTNEY SAVANNAH (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:SAVANNAH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:SAVANNAH
Other - Last Name:MAJOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:45 OLGUIN RD
Mailing Address - Street 2:
Mailing Address - City:JARALES
Mailing Address - State:NM
Mailing Address - Zip Code:87023-9703
Mailing Address - Country:US
Mailing Address - Phone:505-290-4632
Mailing Address - Fax:
Practice Address - Street 1:45 OLGUIN RD
Practice Address - Street 2:
Practice Address - City:JARALES
Practice Address - State:NM
Practice Address - Zip Code:87023-9703
Practice Address - Country:US
Practice Address - Phone:505-290-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0114941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health