Active NPI
Tracie Moore, PH.D.
- Clinical Psychologist
- Twain Harte, CA
National Provider Identifier
1710139720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 12107
- Practice address
- 22569 Middle Camp Rd
Twain Harte, CA 95383-9681 - Phone
- (209) 586-3707
- Fax
- (209) 586-3707
- NPI assigned
- Oct 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 12107 | CA | Primary |
Addresses
Primary practice location
22569 Middle Camp Rd
Twain Harte, CA 95383-9681
Mailing address
22569 Middle Camp Rd
Twain Harte, CA 95383-9681
Phone (209) 586-3707
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224547200000",
"number": "1710139720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22569 MIDDLE CAMP RD",
"city": "TWAIN HARTE",
"state": "CA",
"postal_code": "953839681",
"telephone_number": "209-586-3707",
"fax_number": "209-586-3707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22569 MIDDLE CAMP RD",
"city": "TWAIN HARTE",
"state": "CA",
"postal_code": "953839681",
"telephone_number": "209-586-3707",
"fax_number": "209-586-3707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "TRACIE",
"name_prefix": "Ms.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-21",
"last_updated": "2008-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "12107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twain Harte, CA
- Sarah Kathryn Loughmiller, LM
- Marsha Joellyn McKay, D.O.
- Harold C McKelvey, DDS
- Katielynn Monica McMahon
- Miller Skinner and Dastrup Dental Corporation of Twain Harte
- Michael J. Morrison, D.D.S.
- Linda Sue Postma, RDHAP,RDH
- Krista Dawn Root, R.D.H.
- Edward Riley Russell, DDS
- Starshine Margarita Shirley, SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.