Provider Demographics
NPI:1336757509
Name:MOORE, EVAN (LPCC)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 S HARRISON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3929
Mailing Address - Country:US
Mailing Address - Phone:833-749-3549
Mailing Address - Fax:303-376-4347
Practice Address - Street 1:1777 S HARRISON ST STE 401
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3929
Practice Address - Country:US
Practice Address - Phone:833-749-3549
Practice Address - Fax:303-376-4347
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional