Provider Demographics
NPI:1588855472
Name:MOORE, BRIE ASHLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIE
Middle Name:ASHLEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE D1-28
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6102
Mailing Address - Country:US
Mailing Address - Phone:775-846-2995
Mailing Address - Fax:
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:SUITE D1-28
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6102
Practice Address - Country:US
Practice Address - Phone:775-846-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent