Provider Demographics
NPI:1639438047
Name:MAGOUN MORENO, ALISON MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:MARIA
Last Name:MAGOUN MORENO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30961 AGOURA RD STE 217
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5619
Mailing Address - Country:US
Mailing Address - Phone:805-300-6719
Mailing Address - Fax:805-832-6288
Practice Address - Street 1:30961 AGOURA RD STE 217
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5619
Practice Address - Country:US
Practice Address - Phone:805-300-6719
Practice Address - Fax:805-832-6288
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24406103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist