Patricia Ann Moore, CDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60119738 Issued in WA

Practice address

200 Lilly Rd NE Ste C
Olympia, WA 98506-5080

Phone

(360) 918-8336

Fax

(360) 972-2152

NPI assigned

May 28, 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

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.

• Catholic Community Services Western Washington

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Everett, WA
  • NPI 1669645073
  NPD (past)

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

{
    "created_epoch": "1275004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1467771436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065427",
            "telephone_number": "360-918-8336",
            "fax_number": "360-972-2152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 LILLY RD NE STE C",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065080",
            "telephone_number": "360-918-8336",
            "fax_number": "360-972-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-28",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60119738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2115178",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Moore, LMP
• Kristen Marie Moore
• Melody Lynn Moore, PA-C, LCSW
• Michael D Moore, OD
• Milan Shannon Moore, MD
• Robin Elizabeth Moore
• Samantha Moore, PA-C
• Sarah Moore
• Sarah E Moore, MA, LMHCA
• Scott David Moore, D.C.

• Addiction (Substance Use Disorder) Counselor in Olympia, WA
• Providers in Olympia, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; 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.