Individual
DR. C L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD LP LMFT
Contact information
Practice address
2440 NORTH CHARLES ST, STE 236, N ST PAUL, MN 55109
(651) 771-4766
(651) 771-4784
Mailing address
2440 NORTH CHARLES ST, STE 236, N ST PAUL, MN 55109
(651) 771-4766
(651) 771-4784
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
440
CO
103T00000X
Psychologist
LP2246
MN
103T00000X
Psychologist
PY00000625
WA
106H00000X
Marriage & Family Therapist
Primary
1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104097
U CARE
MN
01
—
212T8PE
BC BS BT
MN
01
—
39036800
WI MEDICAID
WI
01
—
6049644
STATE OF MN
MN
01
—
HP19293
HEALTH PARTNERS
MN
Enumeration date
03/14/2007
Last updated
09/11/2025
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