Provider Demographics
NPI:1285700187
Name:MOORE, DIANNA (LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 FLINTRIDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4264
Mailing Address - Country:US
Mailing Address - Phone:719-260-0780
Mailing Address - Fax:
Practice Address - Street 1:4760 FLINTRIDGE DR STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4264
Practice Address - Country:US
Practice Address - Phone:719-260-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO972930908101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional