Provider Demographics
NPI:1518407162
Name:MOORE, NATHANIEL LEWIS (LMFT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:LEWIS
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 IRVINE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3047
Mailing Address - Country:US
Mailing Address - Phone:714-580-9654
Mailing Address - Fax:
Practice Address - Street 1:7700 IRVINE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3047
Practice Address - Country:US
Practice Address - Phone:714-580-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist