| Doctor Name: | KARA MOULTON |
| NPI Number: | 1174882575 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | IMH13676 |
| Business Practice Address: | 1255 Golfview Ave Bartow, FL - 338306736 |
| Business Phone Number: | 8635190575 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1559, BARTOW |
| State: | FL |
| Postal Code: | 338311559 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2012 |
| NPI Last Update Date: | 06/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMH13676 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |