Provider Demographics
NPI:1609425065
Name:LOUISE MOORE
Entity Type:Organization
Organization Name:LOUISE MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-774-1225
Mailing Address - Street 1:7 4TH ST STE 13
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3072
Mailing Address - Country:US
Mailing Address - Phone:707-774-1225
Mailing Address - Fax:
Practice Address - Street 1:7 4TH ST STE 13
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3072
Practice Address - Country:US
Practice Address - Phone:707-774-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUISE MOORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty