Healthcare Provider Details

I. General information

NPI: 1962321802
Provider Name (Legal Business Name): BROOKE MOSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W HILLCREST DR
THOUSAND OAKS CA
91360-4204
US

IV. Provider business mailing address

3424 HAMLIN AVE
SIMI VALLEY CA
93063-1324
US

V. Phone/Fax

Practice location:
  • Phone: 720-470-8420
  • Fax:
Mailing address:
  • Phone: 720-470-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: