| Moore Psychotherapy Llc | |
|
119 Martin Luther King Jr Blvd Ste 22 Madison WI 53703-3355 | |
| (608) 473-3575 | |
| Not Available |
| Full Name | Moore Psychotherapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 119 Martin Luther King Jr Blvd Ste 22, Madison, Wisconsin |
| Authorized Official Name and Position | Lucas Moore (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6084733575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Psychotherapy Llc 119 Martin Luther King Jr Blvd Ste 22 Madison WI 53703-3355 Ph: (608) 473-3575 | Moore Psychotherapy Llc 119 Martin Luther King Jr Blvd Ste 22 Madison WI 53703-3355 Ph: (608) 473-3575 |
| NPI Number | 1871360115 |
|---|---|
| Provider Enumeration Date | 12/06/2023 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 7113378282 |
|---|---|
| Medicare Enrollment ID | O20240112003074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871360115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lucas E Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477837607 PECOS PAC ID: 9436432606 Enrollment ID: I20170214000355 |
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