Provider Demographics
NPI:1487840807
Name:MOORE, JAMES BENJAMIN (LMFT LMHC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BENJAMIN
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMFT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17250 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177
Mailing Address - Country:US
Mailing Address - Phone:206-542-0956
Mailing Address - Fax:
Practice Address - Street 1:17250 10TH AVE NW
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177
Practice Address - Country:US
Practice Address - Phone:206-542-0956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004942101Y00000X
WALF00001538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor