Active NPI
Irene D Moore, MFTI
- Mental Health Counselor
- Richmond, CA
National Provider Identifier
1710249594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 68350 MFTI
- Practice address
- 4175 Lakeside Dr
Richmond, CA 94806-5774 - Phone
- (510) 262-6551
- Fax
- (510) 222-7085
- NPI assigned
- Jun 8, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 68350 MFTI | CA | Primary |
Addresses
Primary practice location
4175 Lakeside Dr
Richmond, CA 94806-5774
Mailing address
4175 Lakeside Dr
Richmond, CA 94806-5774
Phone (510) 262-6551
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68350 MFTI | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426636800000",
"number": "1710249594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4175 LAKESIDE DR",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948065774",
"telephone_number": "510-262-6551",
"fax_number": "510-222-7085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4175 LAKESIDE DR",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948065774",
"telephone_number": "510-262-6551",
"fax_number": "510-222-7085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "IRENE",
"middle_name": "D",
"credential": "MFTI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-08",
"last_updated": "2015-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "68350 MFTI",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.