Provider Demographics
NPI:1760165831
Name:MOODY, ASHLEY (MA, AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:MA, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44489 TOWN CENTER WAY # D300
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2723
Mailing Address - Country:US
Mailing Address - Phone:760-836-5412
Mailing Address - Fax:
Practice Address - Street 1:1500 PALMA DR FL 2
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6451
Practice Address - Country:US
Practice Address - Phone:805-284-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist