Provider Demographics
NPI:1053077966
Name:MOORE, DAVID (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROOKERIDGE DR # 132
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5702
Mailing Address - Country:US
Mailing Address - Phone:319-214-3194
Mailing Address - Fax:319-774-0026
Practice Address - Street 1:857 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4949
Practice Address - Country:US
Practice Address - Phone:319-800-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health