Provider Demographics
NPI:1437350717
Name:MOORE-ALPAUGH, KATHLEEN ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:MOORE-ALPAUGH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:MOORE-ALPAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:262 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2053
Mailing Address - Country:US
Mailing Address - Phone:626-799-8581
Mailing Address - Fax:626-441-0654
Practice Address - Street 1:1625 CHELSEA RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2419
Practice Address - Country:US
Practice Address - Phone:626-799-8581
Practice Address - Fax:626-441-0654
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT8654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist