Provider Demographics
NPI:1821372087
Name:MOORE, THOMAS LOWELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOWELL
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 HERMITAGE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2517
Mailing Address - Country:US
Mailing Address - Phone:205-910-2233
Mailing Address - Fax:
Practice Address - Street 1:1711 HERMITAGE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2517
Practice Address - Country:US
Practice Address - Phone:205-910-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1402101YP2500X
MS187291103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool