Provider Demographics
NPI:1063716231
Name:MOORE, ALICE ROSE (MSW, PHD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ROSE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ROSE
Other - Last Name:VELARDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 28 3/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-241-6023
Practice Address - Fax:970-242-8303
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA28154104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW28154OtherREGISTERED ASSOCIATE SOCIAL WORKER