Provider Demographics
NPI:1508101437
Name:MOON, INA BETH (MFT)
Entity Type:Individual
Prefix:MS
First Name:INA
Middle Name:BETH
Last Name:MOON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923A FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2819
Mailing Address - Country:US
Mailing Address - Phone:415-705-0813
Mailing Address - Fax:
Practice Address - Street 1:333 VALENCIA ST
Practice Address - Street 2:SUITE #450
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3547
Practice Address - Country:US
Practice Address - Phone:415-705-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist