Provider Demographics
NPI:1710461355
Name:MORAN, SARAH MARGARET
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARGARET
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 BISHOP RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7354
Mailing Address - Country:US
Mailing Address - Phone:360-357-2370
Mailing Address - Fax:360-357-2374
Practice Address - Street 1:1534 BISHOP RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7354
Practice Address - Country:US
Practice Address - Phone:360-357-2370
Practice Address - Fax:360-357-2374
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60800709106H00000X
WALF61004215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist