Provider Demographics
NPI:1699131763
Name:MOORE, BRENT (LPC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NW SALTZMAN RD # 645
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6098
Mailing Address - Country:US
Mailing Address - Phone:971-710-6013
Mailing Address - Fax:
Practice Address - Street 1:515 NW SALTZMAN RD # 645
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6098
Practice Address - Country:US
Practice Address - Phone:971-710-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health