Doctor Name: | SHANE MOES |
NPI Number: | 1043690449 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PC |
License Number: | 007592 |
Business Practice Address: | 4833 Hulmeville Rd Bensalem, PA - 190203023 |
Business Phone Number: | 2156385200 |
Business Fax Number: | 2156382603 |
Mailing Address: | 4833 Hulmeville Rd, BENSALEM |
State: | PA |
Postal Code: | 190203023 |
Phone Number: | 2156385200 |
Fax Number: | 2156382603 |
NPI Enumeration Date: | 06/02/2015 |
NPI Last Update Date: | 06/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 007592 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |