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General NPI Number Information
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NPI Number | 1992201917
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Entity Type | Individual
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Provider Name | KAYLA D MOORER PHD, LP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1330 PAGE DR S STE 102A
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City | FARGO
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State | ND
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Zip | 58103-3562
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Country | US
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Telephone | 701-478-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 12TH ST S
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City | MOORHEAD
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State | MN
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Zip | 56560-3708
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Country | US
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Telephone | 601-580-5453
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2949
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 2949
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 564
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License Number State | ND
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