Provider Demographics
NPI:1235542515
Name:CHRISTA MOODY LMHC
Entity Type:Organization
Organization Name:CHRISTA MOODY LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-261-1345
Mailing Address - Street 1:1010 N 12TH AVE
Mailing Address - Street 2:ROOM 302
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3370
Mailing Address - Country:US
Mailing Address - Phone:850-261-1345
Mailing Address - Fax:
Practice Address - Street 1:1010 N 12TH AVE
Practice Address - Street 2:ROOM 302
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3370
Practice Address - Country:US
Practice Address - Phone:850-261-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty