Cooper Thomas Moore, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH18603 Issued in FL

Practice address

1301 Plantation Island Dr S Ste 202a
St Augustine, FL 32080-3111

Phone

(904) 318-8500

NPI assigned

Jul 23, 2019

Last updated

Oct 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Opted out of Medicare

Yes, effective Jun 27, 2025 through Jun 27, 2027

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.

• Lighthouse Wellness Group

  • Mental Health Counselor
  • St Augustine, FL
  • NPI 1114739604
  NPD (past) Authorized official

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1902459480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S STE 202A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803111",
            "telephone_number": "904-318-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S STE 202A",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803111",
            "telephone_number": "904-318-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "COOPER",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-23",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH18603",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "17529",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Anne Moody, MS CCC-SLP
• Anna Moon Farrell, MS., CCC-SLP
• Melissa S Moon, MOTR
• Garin Mooney
• Christine Moore, ARNP
• Gloria Z. Moore, D.C.
• Gary E Morales Geraldino, M. D.
• Kelsey Morales, OTR/L
• Rachel Moran
• Aubree Mordecai

• Mental Health Counselor in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.