Provider Demographics
NPI:1801127840
Name:MOORE, HEATHER RHEA (LCSW, CADCIII)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RHEA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW, CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N MODOC AVE UNIT 47
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-3696
Mailing Address - Country:US
Mailing Address - Phone:970-373-8276
Mailing Address - Fax:
Practice Address - Street 1:1224 N MODOC AVE UNIT 47
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-3696
Practice Address - Country:US
Practice Address - Phone:970-373-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PROFESSIONALLICENSE101YM0800X
ORL141951041C0700X
COCSW.099247611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health