Provider Demographics
NPI:1043908205
Name:MOORE, JANENE KINGSLEY (AMFT)
Entity Type:Individual
Prefix:
First Name:JANENE
Middle Name:KINGSLEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:JANENE
Other - Middle Name:
Other - Last Name:KINGSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6420 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4732
Mailing Address - Country:US
Mailing Address - Phone:916-257-2274
Mailing Address - Fax:
Practice Address - Street 1:6420 EMERALD DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4732
Practice Address - Country:US
Practice Address - Phone:916-257-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT136024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health