Provider Demographics
NPI:1649632407
Name:MOORE, CAREN R (PHD)
Entity type:Individual
Prefix:DR
First Name:CAREN
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W 3RD ST STE 609
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4467
Mailing Address - Country:US
Mailing Address - Phone:501-263-0400
Mailing Address - Fax:501-492-6495
Practice Address - Street 1:2020 W 3RD ST STE 609
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4467
Practice Address - Country:US
Practice Address - Phone:501-263-0400
Practice Address - Fax:501-492-6495
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-03AP-PL103TB0200X, 103TC1900X, 103TC2200X, 103TF0000X, 103TP2701X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool