Provider Demographics
NPI:1942322557
Name:MOORE, RYAN CURTIS (PHD, PA)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CURTIS
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3043
Mailing Address - Country:US
Mailing Address - Phone:772-220-0611
Mailing Address - Fax:772-220-1186
Practice Address - Street 1:117 SE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3043
Practice Address - Country:US
Practice Address - Phone:772-220-0611
Practice Address - Fax:772-220-1186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health