Charly A Moore, SUDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO60996036 Issued in WA

Practice address

614 Peterson Rd
Burlington, WA 98233-2606

Phone

(360) 757-0131

NPI assigned

Oct 14, 2020

Last updated

Oct 14, 2020By 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

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.

• Catholic Community Services of Western Washington

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Burlington, WA
  • NPI 1225449929
  NPD (past)

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1528666369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 LABOUNTY DR # 9-248",
            "city": "FERNDALE",
            "state": "WA",
            "postal_code": "982488959",
            "telephone_number": "360-510-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 PETERSON RD",
            "city": "BURLINGTON",
            "state": "WA",
            "postal_code": "982332606",
            "telephone_number": "360-757-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CHARLY",
        "middle_name": "A",
        "credential": "SUDPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60996036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Marie Miesel, DDS
• Amy Angelica Miller, CO.61653568
• Natalie Miller, SUDP
• Ilya B Mironov, D.D.S.
• Brian Moore
• Sharlene Ihilani Moore, RD, CD
• Roseanne Moran
• Amber Dawn Morris
• Brita Morris
• Michelle K Moser, RPH

• Addiction (Substance Use Disorder) Counselor in Burlington, WA
• Providers in Burlington, 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 Oct 14, 2020; 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.