Provider Demographics
NPI:1669819181
Name:MOORE, SHARON E (MA MFT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ELLIOTT CIR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-4111
Mailing Address - Country:US
Mailing Address - Phone:865-482-0124
Mailing Address - Fax:
Practice Address - Street 1:107 ELLIOTT CIR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-4111
Practice Address - Country:US
Practice Address - Phone:865-482-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist