Provider Demographics
NPI:1851081368
Name:MOORE, CHRISTOPHER BLAKE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BLAKE
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:MO
Mailing Address - Zip Code:63933-1551
Mailing Address - Country:US
Mailing Address - Phone:573-227-4387
Mailing Address - Fax:
Practice Address - Street 1:117 S ASH ST
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:MO
Practice Address - Zip Code:63933-1551
Practice Address - Country:US
Practice Address - Phone:573-227-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician