Provider Demographics
NPI:1205448164
Name:MOORE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:MOORE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-657-6917
Mailing Address - Street 1:465 NE 181ST AVE # 215
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6660
Mailing Address - Country:US
Mailing Address - Phone:503-673-6161
Mailing Address - Fax:480-405-7775
Practice Address - Street 1:2053 SE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233
Practice Address - Country:US
Practice Address - Phone:503-673-6161
Practice Address - Fax:480-405-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty