Provider Demographics
NPI:1790403046
Name:MOORE, AMBER FAITH (MHP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:FAITH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 CANE GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-2064
Mailing Address - Country:US
Mailing Address - Phone:630-788-9011
Mailing Address - Fax:
Practice Address - Street 1:289 CANE GARDEN CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-2064
Practice Address - Country:US
Practice Address - Phone:630-788-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health