Provider Demographics
NPI:1013566587
Name:MOON, CHRISTINE E (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:MOON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110183
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-0183
Mailing Address - Country:US
Mailing Address - Phone:408-482-7605
Mailing Address - Fax:
Practice Address - Street 1:20688 4TH ST # 3
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5894
Practice Address - Country:US
Practice Address - Phone:408-857-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist