Provider Demographics
NPI:1114492477
Name:MOORE, JAMES ANDERSON (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANDERSON
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 HOLLYWOOD BLVD STE 443
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8912
Mailing Address - Country:US
Mailing Address - Phone:323-364-6065
Mailing Address - Fax:
Practice Address - Street 1:205 1/2 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3706
Practice Address - Country:US
Practice Address - Phone:323-364-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist