Provider Demographics
NPI: | 1801212584 |
---|---|
Name: | MOORE, JEANNE (PHD,LMFT,MA,MEDIATOR) |
Entity Type: | Individual |
Prefix: | |
First Name: | JEANNE |
Middle Name: | |
Last Name: | MOORE |
Suffix: | |
Gender: | F |
Credentials: | PHD,LMFT,MA,MEDIATOR |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 40693 |
Mailing Address - Street 2: | |
Mailing Address - City: | BAKERSFIELD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93384-0693 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 661-831-3185 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 900 BALDWIN RD # A |
Practice Address - Street 2: | |
Practice Address - City: | BAKERSFIELD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93304-4202 |
Practice Address - Country: | US |
Practice Address - Phone: | 661-831-3185 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2014-03-05 |
Last Update Date: | 2015-04-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | LMFT12300 | 174V00000X |
CA | STC330468 | 174400000X |
CA | MJ12300 | 101Y00000X |
CA | LFT12300 | 171M00000X |
CA | M12300 | 101YP2500X, 103K00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 106H00000X |
CA | LMFCT12300 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 174V00000X | Other Service Providers | Clinical Ethicist | |
No | 174400000X | Other Service Providers | Specialist | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |