Moore, Sally Ruth

Moore, Sally Ruth is an sole proprietor health care provider with primary practice located at 430 Oak Grove St 302, Minneapolis MN 55403-3253. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Counseling is her primary health care specialty. Moore, Sally Ruth can be contacted via phone (612) 871-4336.

Contact Information

Primary practice address
430 Oak Grove St 302 Minneapolis MN 55403-3253
Phone: (612) 871-4336
Fax: (612) 929-2331
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X LP1891 Minnesota
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 809 Minnesota

Profile Details

NPI number 1518044734
LBN Legal business name Moore, Sally Ruth
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 1st, 2006
Last updated Nov 8th, 2007 - about 18 years 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 1518044734 NPPES
Minnesota Other 61-69529 MEDICA
Minnesota Other 67Q05MO MEDICA
Minnesota Other 1016212 MEDICA
Minnesota MEDICAID 621853900 MEDICA

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