Doctor Name: | GEORGE THOMAS MOORE |
NPI Number: | 1174935423 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CDPT |
License Number: | CO 60466512 |
Business Practice Address: | 1204 Connors Rd Snohomish, WA - 982909625 |
Business Phone Number: | 4253978915 |
Business Fax Number: | |
Mailing Address: | 1204 Connors Rd, SNOHOMISH |
State: | WA |
Postal Code: | 982909625 |
Phone Number: | 4253978915 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2014 |
NPI Last Update Date: | 05/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CO 60466512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |