Provider Demographics
NPI:1447326491
Name:MILLER-MOE, REBECCA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARIE
Last Name:MILLER-MOE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4445
Mailing Address - Country:US
Mailing Address - Phone:503-581-0657
Mailing Address - Fax:503-581-4025
Practice Address - Street 1:2659 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4445
Practice Address - Country:US
Practice Address - Phone:503-581-0657
Practice Address - Fax:503-581-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1211103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling