Provider Demographics
NPI:1669804779
Name:MOORE, CHRISTOPHER TREVOR
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:TREVOR
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 W BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4357
Mailing Address - Country:US
Mailing Address - Phone:702-521-9653
Mailing Address - Fax:
Practice Address - Street 1:6260 W BROOKS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4357
Practice Address - Country:US
Practice Address - Phone:702-521-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000086266101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool