Christardra Moore, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4636 Issued in LA

Practice address

4800 S Grand St
Monroe, LA 71202-6412

Phone

(318) 362-3339

Fax

(318) 362-3336

NPI assigned

Mar 22, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Christardra Johnson Former name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Delta Human Services AuthorityGroup PAC ID 2961726005, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Delta Human Services Authority

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Monroe, LA
  • NPI 1033551833
  Medicare reassignment Care Compare group NPD
• Northeast Delta Human Services Authority

  • Primary Care Clinic/Center
  • Bastrop, LA
  • NPI 1225782196
  NPD
• Northeast Delta Human Services Authority

  • Primary Care Clinic/Center
  • Monroe, LA
  • NPI 1790158681
  NPD

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1942269394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 FERRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013210",
            "telephone_number": "318-362-3270",
            "fax_number": "318-362-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 S GRAND ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026412",
            "telephone_number": "318-362-3339",
            "fax_number": "318-362-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CHRISTARDRA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A0305049",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P0704014",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "4636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3758342",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTARDRA",
            "last_name": "JOHNSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leonard Montgomery
• Marybeth Montrichard, MD
• Bridgette Moore, M.A., CCC-SLP
• Bryan Anderson Moore, PT
• Calandra M Moore, FNP
• Crystell Moore
• Daniel L. Moore, PH.D.
• Debra Shelia Moore
• Holly Kebodeaux Moore, L-SLP; CCC-SLP
• Kareem Moore

• Professional Counselor in Monroe, LA
• Providers in Monroe, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.