Provider Demographics
NPI:1477524734
Name:MOORE, PHILIP FREDERIC (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:FREDERIC
Last Name:MOORE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38790 SKY CANYON DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2537
Mailing Address - Country:US
Mailing Address - Phone:951-600-2945
Mailing Address - Fax:951-600-2985
Practice Address - Street 1:38790 SKY CANYON DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2537
Practice Address - Country:US
Practice Address - Phone:951-600-2945
Practice Address - Fax:951-600-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35867106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist