Moore, Teddy

Moore, Teddy is an sole proprietor health care provider with primary practice located at 323 Marion Pike Ste 1 , Coal Grove OH 45638-2958. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Other Service Providers / Case Manager/Care Coordinator, Other Service Providers / Peer Specialist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Moore, Teddy can be contacted via phone (740) 237-4981.

Contact Information

Primary practice address
323 Marion Pike Ste 1 Coal Grove OH 45638-2958
Phone: (740) 237-4981
Fax: (877) 325-2816
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Other Service Providers / Peer Specialist 175T00000X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CDCA.183837 Ohio

Profile Details

NPI number 1891421772
LBN Legal business name Moore, Teddy
Credentials CDCA.183837
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 25th, 2022
Last updated Feb 16th, 2024 - about 9 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891421772 NPPES
Ohio MEDICAID 0498102

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