Doctor Name: | MRS. MARIE MOORE |
NPI Number: | 1013328467 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, MFTI |
License Number: | 73678 |
Business Practice Address: | 222 W Main St Ste 101 Tustin, CA - 927807711 |
Business Phone Number: | 9493284110 |
Business Fax Number: | |
Mailing Address: | 222 W. Main Street, #101, TUSTIN |
State: | CA |
Postal Code: | 92780 |
Phone Number: | 9493284110 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2014 |
NPI Last Update Date: | 05/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 73678 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |