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General NPI Number Information
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NPI Number | 1063757920
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Entity Type | Individual
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Provider Name | JESSICA RAE MORAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 334 VIA VERA CRUZ SUITE 208
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City | SAN MARCOS
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State | CA
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Zip | 92078-2635
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Country | US
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Telephone | 442-222-1108
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Fax |
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Provider Business Mailing Address
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Address Line | 481 CHARDONNAY CT
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City | SAN MARCOS
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State | CA
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Zip | 92069-7820
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Country | US
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Telephone | 909-518-6455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 72650
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 85864
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License Number State | CA
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