Shanice Kaitlyn Jaye Moore

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15527-RAC Issued in CA

Practice address

2298 Norris Ave
Crescent City, CA 95531-9344

Phone

(707) 464-2919

NPI assigned

Mar 10, 2020

Last updated

Mar 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• United Indian Health Services, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Crescent City, CA
  • NPI 1346041746
  NPD
• United Indian Health Services, Inc.

  • Primary Care Clinic/Center
  • Crescent City, CA
  • NPI 1043216021

  Addiction (Substance Use Disorder)

  NPD (past)
• United Indian Health Services, Inc.

  • Primary Care Clinic/Center
  • Arcata, CA
  • NPI 1497751572

  Addiction (Substance Use Disorder)

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1043845092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WEEOT WAY",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214734",
            "telephone_number": "707-825-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2298 NORRIS AVE",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955319344",
            "telephone_number": "707-464-2919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Weeot Way",
            "address_purpose": "LOCATION",
            "city": "Arcata",
            "state": "CA",
            "postal_code": "955214734",
            "country_code": "US",
            "telephone_number": "707-825-5060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1675 Northcrest Dr",
            "address_purpose": "LOCATION",
            "city": "Crescent City",
            "state": "CA",
            "postal_code": "955318928",
            "country_code": "US",
            "telephone_number": "707-464-2750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHANICE",
        "middle_name": "KAITLYN JAYE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "15527-RAC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Mitchell
• Katherine Mize, RN
• Richard Jeffrey Mize, M.D.
• Brian Mockler, PHARMD
• Moonstone Behavioral Solutions LLC
• Morgan Hill Emergency Medical Group
• James A Morrow, D.O.
• Allegra Morton, DPT
• Parsa Motavalli
• John L Moulton III, PH D

• Addiction (Substance Use Disorder) Counselor in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.