Provider Demographics
NPI:1255494647
Name:MOODY, KAMERON KRISTEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KAMERON
Middle Name:KRISTEN
Last Name:MOODY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:KRISTEN
Other - Last Name:MEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:19720 VENTURA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:310-993-8941
Mailing Address - Fax:
Practice Address - Street 1:19720 VENTURA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:310-993-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40158101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist