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General NPI Number Information
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NPI Number | 1245588987
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Entity Type | Individual
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Provider Name | JILLIAN LEIGH MOORE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 145 HODENCAMP RD STE 100
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City | THOUSAND OAKS
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State | CA
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Zip | 91360
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Country | US
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Telephone | 805-449-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 359 COUNTRY CLUB DR APT 7
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City | SIMI VALLEY
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State | CA
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Zip | 93065-6690
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Country | US
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Telephone | 714-401-9239
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY29908
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY29908
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License Number State | CA
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