Provider Demographics
NPI:1265537344
Name:MOORE, JAMES E (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 AURORA AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-859-5030
Mailing Address - Fax:206-859-5031
Practice Address - Street 1:4300 AURORA AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-859-5030
Practice Address - Fax:206-859-5031
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001021103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0200922OtherWORKERS COMP
WA1263451OtherUNITED HEALTHCARE
WA1263451OtherUNITED HEALTHCARE