Provider Demographics
NPI:1184087900
Name:MOORE, QUINCY
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2505
Mailing Address - Country:US
Mailing Address - Phone:541-284-7800
Mailing Address - Fax:541-284-7804
Practice Address - Street 1:3692 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5306
Practice Address - Country:US
Practice Address - Phone:541-284-7800
Practice Address - Fax:541-284-7804
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health