Provider Demographics
NPI:1407581226
Name:MOORE, LEVI
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANEE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10530 W LANCELOT AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10530 W LANCELOT AVE
Practice Address - Street 2:TELEHEALTH ONLY
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5249
Practice Address - Country:US
Practice Address - Phone:831-251-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical