Phillip Moore, MA LPC-IT, SAC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7610-226 Issued in WI

Practice address

11414 W Park PL Ste 202
Milwaukee, WI 53224-3500

Phone

(920) 204-6668

NPI assigned

Mar 18, 2024

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1891554317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "920-204-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11414 W PARK PL STE 202",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532243500",
            "telephone_number": "920-204-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PHILLIP",
        "name_prefix": "Mr.",
        "credential": "MA LPC-IT, SAC-IT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20136-130",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7610-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria A Moore, ICS
• Monifa Moore
• Nidra Suwan Moore, R.N.
• Patrice Moore, LPC
• Peggy Kay Moore, OT
• Rasha Iman Moore, ADMIN, AFH
• Ronda Denise Moore, APSW
• Rosann Moore, L.P.N
• Shamaine Moore
• Tania Sheri Moore, REGISTERED NURSE

• Professional Counselor in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.