Provider Demographics
NPI:1447524665
Name:MOORE, SYLVIA (MSC, CAC III)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 PONY EXPRESS DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9605
Mailing Address - Country:US
Mailing Address - Phone:303-805-1218
Mailing Address - Fax:303-805-3679
Practice Address - Street 1:18425 PONY EXPRESS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9605
Practice Address - Country:US
Practice Address - Phone:303-805-1218
Practice Address - Fax:303-805-3679
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-7273101YA0400X
CONLC-10953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02656027Medicaid