Sally Ruth Moore, PSY.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP1891 Issued in MN

Practice address

430 Oak Grove St
302
Minneapolis, MN 55403-3253

Phone

(612) 871-4336

Fax

(612) 929-2331

NPI assigned

Nov 1, 2006

Last updated

Nov 8, 2007By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Parkside Psychology, Inc.

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1114175791
  Authorized official Same address or phone

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194480000000",
    "number": "1518044734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 OAK GROVE ST",
            "address_2": "302",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033253",
            "telephone_number": "612-871-4336",
            "fax_number": "612-929-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 OAK GROVE ST",
            "address_2": "302",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033253",
            "telephone_number": "612-871-4336",
            "fax_number": "612-929-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SALLY",
        "middle_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP1891",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Aili Moore, D.C.
• Rebecca Moore, LICSW
• Rolisha Moore
• Rosemary Brown Moore, MSW
• Rosemary Jean Moore, MSN
• Samuel Moore
• Sandy Moore
• Sarah Danielson Moore, SLP
• Sydney Hope Moore, MD
• Timothy Richard Moore, PH.D., LP, BCBA-D

• Counseling Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; 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.