Provider Demographics
NPI:1619171162
Name:BOOHAR, ELLEN MOORE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MOORE
Last Name:BOOHAR
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 1:823 ELM ST STE 234
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4172
Mailing Address - Country:US
Mailing Address - Phone:910-661-3993
Mailing Address - Fax:844-522-0838
Practice Address - Street 1:823 ELM ST STE 234
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4172
Practice Address - Country:US
Practice Address - Phone:910-661-3993
Practice Address - Fax:844-522-0838
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1376103T00000X
NC5714103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist