Provider Demographics
NPI:1659546638
Name:MOORE, REBA ANN (PSYS)
Entity Type:Individual
Prefix:MRS
First Name:REBA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 BEE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-7804
Mailing Address - Country:US
Mailing Address - Phone:606-523-9723
Mailing Address - Fax:
Practice Address - Street 1:85 W POINT DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8898
Practice Address - Country:US
Practice Address - Phone:606-523-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0008103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities