Provider Demographics
NPI:1831478031
Name:MOORE, GREGORY D (LMFTA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33507 9TH AVE S
Mailing Address - Street 2:SUITE C - 2
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6397
Mailing Address - Country:US
Mailing Address - Phone:253-205-5966
Mailing Address - Fax:
Practice Address - Street 1:33507 9TH AVE S
Practice Address - Street 2:SUITE C - 2
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6397
Practice Address - Country:US
Practice Address - Phone:253-205-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60231748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist