Audrey Elaine Moore, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

22964 Issued in AZ

Practice address

702 W Hillside Ave
Prescott, AZ 86301-1913

Phone

(855) 746-3633

NPI assigned

Aug 7, 2023

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 names 1

• Audrey Stewart Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1558043687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 MARKET ST APT 2086",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863146517",
            "telephone_number": "208-505-8933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W HILLSIDE AVE",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011913",
            "telephone_number": "855-746-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "AUDREY",
        "middle_name": "ELAINE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-07",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "22964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "STEWART",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monty Shultz Counseling & Neurofeedback LLC
• Monty Shultz Counseling LLC
• Lisa Ann Monville
• Deborah Moon, PT
• Molly Anne Moore-Pullin, A.N.P.
• Bertha Jean Moore, RN
• Jennifer Anne Moore, FNP-BC
• Kristin Moore
• Laura Jeanne Moore, LPC
• Mary Ann Moore

• All providers in Prescott, AZ
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.