Provider Demographics
NPI:1083139281
Name:MOORE, KAYLA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 211TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8676
Mailing Address - Country:US
Mailing Address - Phone:206-948-5189
Mailing Address - Fax:
Practice Address - Street 1:4141 6TH AVE STE C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4034
Practice Address - Country:US
Practice Address - Phone:253-525-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALMFTA.MG.60778639106H00000X
WALF60995323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist