Provider Demographics
NPI:1063045714
Name:MORAN, DAVID C (LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MORAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 LAKE MICHAELA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7955
Mailing Address - Country:US
Mailing Address - Phone:703-560-4777
Mailing Address - Fax:
Practice Address - Street 1:1801 S MILLER RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5702
Practice Address - Country:US
Practice Address - Phone:813-689-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty