Provider Demographics
NPI:1982841755
Name:MOORE, ROXANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 E MAPLE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5708
Mailing Address - Country:US
Mailing Address - Phone:360-393-9939
Mailing Address - Fax:888-841-4142
Practice Address - Street 1:1313 E MAPLE ST STE 210
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-393-9939
Practice Address - Fax:888-841-4142
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60652612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist