Provider Demographics
NPI:1588203038
Name:DR. MOORE'S TELE-THERAPY
Entity Type:Organization
Organization Name:DR. MOORE'S TELE-THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOORE-MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTI, PSYD
Authorized Official - Phone:702-815-9494
Mailing Address - Street 1:304 S JONES BLVD STE 264
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:702-815-9494
Mailing Address - Fax:702-553-3417
Practice Address - Street 1:304 S JONES BLVD STE 264
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2623
Practice Address - Country:US
Practice Address - Phone:702-815-9494
Practice Address - Fax:702-553-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty