Provider Demographics
NPI:1417492851
Name:MOORE, MICHAL SIERRA (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:SIERRA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHAL
Other - Middle Name:
Other - Last Name:DEDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:20300 SE MORRISON TER APT F2039
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-2274
Mailing Address - Country:US
Mailing Address - Phone:650-382-9218
Mailing Address - Fax:
Practice Address - Street 1:1500 NW BETHANY BLVD STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5238
Practice Address - Country:US
Practice Address - Phone:503-233-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7904101Y00000X
ORR7792101Y00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst