MEDICARE: ERIN MOFFAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1407420631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MOFFAT

Provider Business Mailing Address
First Line	:	21600 OXNARD ST STE 1800
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3079 HARRISON AVE STE 26
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7978
Country	:	US
Telephone Number	:	530-578-3859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2021
Last Update Date	:	05/13/2021

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Directions to “ ERIN MOFFAT ” Practice Location

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