Healthcare Provider Details

I. General information

NPI: 1780597120
Provider Name (Legal Business Name): KEITH MOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18121 E HAMPDEN AVE # 886
AURORA CO
80013-3590
US

IV. Provider business mailing address

18121 E HAMPDEN AVE # 886
AURORA CO
80013-3590
US

V. Phone/Fax

Practice location:
  • Phone: 321-380-2496
  • Fax:
Mailing address:
  • Phone: 321-380-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0014466
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: