Provider Demographics
NPI:1265839856
Name:KELLY DORR MOATES, LMFT, LLC
Entity Type:Organization
Organization Name:KELLY DORR MOATES, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DORR
Authorized Official - Last Name:MOATES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:205-914-3035
Mailing Address - Street 1:326 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1425
Mailing Address - Country:US
Mailing Address - Phone:205-914-3035
Mailing Address - Fax:
Practice Address - Street 1:326 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1425
Practice Address - Country:US
Practice Address - Phone:205-914-3035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty