Provider Demographics
NPI:1689839466
Name:MOORE, ROBIN MARIE (MS LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22010 17TH AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8486
Mailing Address - Country:US
Mailing Address - Phone:206-517-1435
Mailing Address - Fax:425-487-4884
Practice Address - Street 1:22010 17TH AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8486
Practice Address - Country:US
Practice Address - Phone:206-517-7699
Practice Address - Fax:425-487-4884
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WALH60124105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor