Individual
RENEE Y MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2 RIVERCHASE OFFICE PLZ STE 115, HOOVER, AL 35244-2810
(205) 403-0955
Mailing address
2 RIVERCHASE OFFICE PLZ STE 115, HOOVER, AL 35244-2810
(205) 403-0955
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LC1968
MD
103T00000X
Psychologist
04789
MD
103T00000X
Psychologist
Primary
1785
AL
103T00000X
Psychologist
PSY1000811
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410230400
—
MD
01
—
614S
MEDICARE PTAN
MD
Enumeration date
04/10/2007
Last updated
02/28/2017
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