Provider Demographics
NPI:1114055308
Name:MOCH, ELISHEVA RENA (MA, LMHC, ATR)
Entity Type:Individual
Prefix:MS
First Name:ELISHEVA
Middle Name:RENA
Last Name:MOCH
Suffix:
Gender:F
Credentials:MA, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6328
Mailing Address - Country:US
Mailing Address - Phone:303-547-6254
Mailing Address - Fax:
Practice Address - Street 1:530 BEECH ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6328
Practice Address - Country:US
Practice Address - Phone:360-821-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health