Provider Demographics
NPI:1205461787
Name:MOORE, ALEXIS KAYBROOK (MPH, CAAR)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:KAYBROOK
Last Name:MOORE
Suffix:
Gender:F
Credentials:MPH, CAAR
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:KAYBROOK
Other - Last Name:BERTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:403 W STATE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6140
Mailing Address - Country:US
Mailing Address - Phone:360-986-0996
Mailing Address - Fax:
Practice Address - Street 1:403 W STATE ST STE 206
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6140
Practice Address - Country:US
Practice Address - Phone:360-986-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61025586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health