Provider Demographics
NPI:1932139912
Name:MOORE, RICHARD A (LMHC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ROBERT J CONLAN BLVD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3502
Mailing Address - Country:US
Mailing Address - Phone:321-723-8823
Mailing Address - Fax:321-723-9551
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3502
Practice Address - Country:US
Practice Address - Phone:321-723-8823
Practice Address - Fax:321-723-9551
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health