| Doctor Name: | MR. GEORGE MOORE |
| NPI Number: | 1558503847 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADAC |
| License Number: | 0110951 |
| Business Practice Address: | 101 D Avenue Zuni, NM - 87327 |
| Business Phone Number: | 5057824710 |
| Business Fax Number: | 5057825880 |
| Mailing Address: | Po Box 339, ZUNI |
| State: | NM |
| Postal Code: | 873270339 |
| Phone Number: | 5057824710 |
| Fax Number: | 5057825880 |
| NPI Enumeration Date: | 04/01/2009 |
| NPI Last Update Date: | 04/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0110951 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |