Provider Demographics
NPI:1689762346
Name:MOORE, JEANNE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30131 TOWN CENTER DR SUITE 235
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2033
Mailing Address - Country:US
Mailing Address - Phone:949-433-9546
Mailing Address - Fax:949-215-8408
Practice Address - Street 1:30131 TOWN CENTER DR SUITE 235
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2033
Practice Address - Country:US
Practice Address - Phone:949-433-9546
Practice Address - Fax:949-215-8408
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17812103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFW675AMedicaid