Provider Demographics
NPI:1821549791
Name:MOORE, TAWNA CHARI (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TAWNA
Middle Name:CHARI
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W VETERANS BLVD
Mailing Address - Street 2:MAIL CODE #122
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-5566
Mailing Address - Country:US
Mailing Address - Phone:432-263-7361
Mailing Address - Fax:432-268-5074
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:MAIL CODE #122
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:432-268-5074
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57550104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker