Healthcare Provider Details

I. General information

NPI: 1659552917
Provider Name (Legal Business Name): KIM ANN MOOR MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 HUBBARD LN STE C
EUREKA CA
95501
US

IV. Provider business mailing address

3009 HUBBARD LN STE C
EUREKA CA
95501-4801
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-1484
  • Fax: 707-441-1484
Mailing address:
  • Phone: 707-441-1484
  • Fax: 707-441-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT37499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: