Provider Demographics
NPI:1093882599
Name:MOODY, JEFF ALLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:ALLEN
Last Name:MOODY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E 2ND ST STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3077
Mailing Address - Country:US
Mailing Address - Phone:405-620-3508
Mailing Address - Fax:
Practice Address - Street 1:307 E 2ND ST STE 250
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3077
Practice Address - Country:US
Practice Address - Phone:405-620-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist