Provider Demographics
NPI:1558872283
Name:MOORE, GEOFFREY KURT (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:KURT
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 BLAKE ST APT 3S
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1358
Mailing Address - Country:US
Mailing Address - Phone:303-449-4162
Mailing Address - Fax:
Practice Address - Street 1:2150 W 29TH AVE STE 330
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3889
Practice Address - Country:US
Practice Address - Phone:303-449-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3260103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling