Provider Demographics
NPI:1689757650
Name:MOORE, EMORY W (LPCC)
Entity Type:Individual
Prefix:
First Name:EMORY
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94508
Mailing Address - Street 2:ALBUQUERQUE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199
Mailing Address - Country:US
Mailing Address - Phone:505-384-7352
Mailing Address - Fax:
Practice Address - Street 1:4481 CORRALES RD STE 9
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-8615
Practice Address - Country:US
Practice Address - Phone:505-554-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM121711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83276319Medicaid