Provider Demographics
NPI:1336959972
Name:MOORE, TYRONE (MA, LCDC)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5404
Mailing Address - Country:US
Mailing Address - Phone:877-627-0369
Mailing Address - Fax:844-251-4889
Practice Address - Street 1:1390 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5404
Practice Address - Country:US
Practice Address - Phone:877-627-0369
Practice Address - Fax:844-251-4889
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17069101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)