Individual
MR. TERRANCE R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2255 S 132ND ST, SUITE 200, OMAHA, NE 68144-2573
(402) 334-1122
(402) 334-8171
Mailing address
2255 S 132ND ST, SUITE 200, OMAHA, NE 68144-2573
(402) 334-1122
(402) 334-8171
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24
NE
1041C0700X
Clinical Social Worker
31
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47076860626
—
NE
Enumeration date
08/25/2005
Last updated
07/23/2010
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