Provider Demographics
NPI:1154830552
Name:MOORE, ELISE GENEVIEVE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:GENEVIEVE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 VENTURA CANYON AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6352
Mailing Address - Country:US
Mailing Address - Phone:661-645-2798
Mailing Address - Fax:661-259-9658
Practice Address - Street 1:19040 SOLEDAD CANYON RD STE 260
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-3363
Practice Address - Country:US
Practice Address - Phone:661-542-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist