Individual
LILA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1174 PRINCES CIR, SYRACUSE, UT 84075-6830
(918) 209-8138
Mailing address
1174 PRINCES CIR, SYRACUSE, UT 84075-6830
(918) 209-8138
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13642618-3501
UT
1041C0700X
Clinical Social Worker
55396
TX
1041C0700X
Clinical Social Worker
5585
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13642618-3501
LCSW
UT
01
—
41630
LCSW
ID
01
—
55396
LICENSE
TX
01
—
5585
ISSUER
OK
Enumeration date
02/03/2009
Last updated
05/08/2025
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