Organization
TIMOTHY MOORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MOORE (OWNER)
(541) 306-0474
Entity
Organization
Contact information
Practice address
384 SW UPPER TERRACE DR STE 212, BEND, OR 97702-3514
(541) 306-0474
Mailing address
250 NW ST HELENS PL, BEND, OR 97703-2661
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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