Healthcare Provider Details

I. General information

NPI: 1619595600
Provider Name (Legal Business Name): JEFF A MOODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 SW TUALATIN SHERWOOD RD STE 200
TUALATIN OR
97062-8620
US

IV. Provider business mailing address

801 E HILLTOP DR
NEWBERG OR
97132-9044
US

V. Phone/Fax

Practice location:
  • Phone: 971-254-3762
  • Fax: 971-279-7352
Mailing address:
  • Phone: 405-620-3508
  • Fax: 971-279-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFF MOODY
Title or Position: OWNER/PROVIDER
Credential: PSYD
Phone: 971-254-3762