Provider Demographics
NPI:1841438561
Name:MOORE, LILA (LCSW)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:
Last Name:MOORE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 PRINCES CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-6830
Mailing Address - Country:US
Mailing Address - Phone:918-209-8138
Mailing Address - Fax:
Practice Address - Street 1:1174 PRINCES CIR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-6830
Practice Address - Country:US
Practice Address - Phone:918-209-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553961041C0700X
OK55851041C0700X
UT13642618-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55396OtherLICENSE
ID41630OtherLCSW
UT13642618-3501OtherLCSW
OK5585OtherISSUER