Provider Demographics
NPI:1235327248
Name:MOATES, KELLY DORR (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DORR
Last Name:MOATES
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 1:224 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2344
Mailing Address - Country:US
Mailing Address - Phone:256-341-0811
Mailing Address - Fax:256-341-9358
Practice Address - Street 1:224 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-2344
Practice Address - Country:US
Practice Address - Phone:256-341-0811
Practice Address - Fax:256-341-9358
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51541679OtherFEDERAL BCBS
AL51528347OtherBCBS OF AL