Provider Demographics
NPI:1083349112
Name:MOORE, COLIN PORTER (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:PORTER
Last Name:MOORE
Suffix:
Gender:M
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 1:2875 S KING ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3508
Mailing Address - Country:US
Mailing Address - Phone:808-460-3700
Mailing Address - Fax:
Practice Address - Street 1:2875 S KING ST STE 201A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3508
Practice Address - Country:US
Practice Address - Phone:808-460-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
HIMFT-837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist