Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | C2793 | OR |
N | 101YP2500X | Professional Counselor | C2793 | OR |
NPI | 1003981085 |
---|---|
Provider Name | Jeffrey M Moore |
First Address | Portland, OR 97209-3580 |
Second Address | Portland, OR 97209-3580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 01/02/2013 |