Basic Information
| Provider Information | |||||||||
| NPI: | 1801127840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829015610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073526677 | ||||||||
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| Practice Location | |||||||||
| Address1: | 323 E 27TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805383203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703103406 | ||||||||
| FaxNumber: | 3073526614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2010 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 09924716 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.