Provider Demographics
NPI:1376940346
Name:MOORE, SOPHIE IRENE
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:IRENE
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 1:1321 SOUTH RAINBOW BLVD. SUITE #240
Mailing Address - Street 2:ASPIRE BEHAVIORAI HEALTH
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-826-3219
Mailing Address - Fax:
Practice Address - Street 1:3085 S. JONES BLVD. SUITE D
Practice Address - Street 2:MOBILE MENTAL HEALTH SUPPORT SERVICES, INC.
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146
Practice Address - Country:US
Practice Address - Phone:702-826-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner