Provider Demographics
NPI:1659401073
Name:MOORE, T.F. E (MA)
Entity Type:Individual
Prefix:MR
First Name:T.F.
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:TIMOTHY-FRANCIS
Other - Middle Name:E,
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2442 GRAVELLY BEACH LOOP, N.W. # 6
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8821
Mailing Address - Country:US
Mailing Address - Phone:360-867-1375
Mailing Address - Fax:
Practice Address - Street 1:135 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4817
Practice Address - Country:US
Practice Address - Phone:360-748-6696
Practice Address - Fax:360-748-0627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00033328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health