Tina Marie Moore-Boettcher

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CG 60603619 Issued in WA

Practice address

1201 S Proctor St
Tacoma, WA 98405-2047

Phone

(253) 396-5800

Fax

(253) 759-7008

NPI assigned

Jul 4, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Nisqually Tribe

  • Clinic/Center
  • Olympia, WA
  • NPI 1467644914
  NPD (past)

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

{
    "created_epoch": "1467590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467590400000",
    "number": "1053763904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S PROCTOR ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052047",
            "telephone_number": "253-396-5800",
            "fax_number": "253-759-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S PROCTOR ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052047",
            "telephone_number": "253-396-5800",
            "fax_number": "253-759-7008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE-BOETTCHER",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-04",
        "last_updated": "2016-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG 60603619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNSELOR AGENCY AFFILIATED REGISTRATION",
            "identifier": "CG 60603619",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moona Khan DDS PS
• Nikki Angeline Moonbeam
• Nancy Hancock Mooney, LICSW
• Andrea Mooradian, MSW
• Jason Scott Moorash
• Allison Moore
• Andrea Moore, ARNP
• Angela Marie Moore, CARE COORDINATOR 1
• Armond Moore
• Ashley Ann Moore

• Mental Health Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2016; 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.