Shannon Monique Moore, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

55981 Issued in MS

Practice address

1675 Lakeland Dr Ste 304
Jackson, MS 39216

Phone

(769) 524-4578

Fax

(769) 524-4630

NPI assigned

Aug 9, 2010

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Genesis Behavioral Health Services, LLC

  • Psychologist
  • Ridgeland, MS
  • NPI 1265043962
  NPD Authorized official

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1154636611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13563",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392363563",
            "telephone_number": "769-524-4578",
            "fax_number": "769-524-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 LAKELAND DR STE 304",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "769-524-4578",
            "fax_number": "769-524-4630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 Albion St Ste 114",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372082918",
            "country_code": "US",
            "telephone_number": "615-327-4751 x63221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHANNON",
        "middle_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-09",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MS",
            "license": "55981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Keith Moore, R.N.
• Robert L Moore, M.D.
• Sanetria Moore, CMHT, CCSS
• Shakari Moore
• Shanna Moore, LCSW
• Steven Patrick Moore, RPT
• Walter Thomas Moore, MD
• Mooreco
• Carolina Morales
• Catherine Coleman Mordecai, FNP-C

• Clinical Psychologist in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinical Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.