Provider Demographics
NPI:1871041855
Name:MOORE, ANTHONY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 CAHALAN AVE # 23075
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3008
Mailing Address - Country:US
Mailing Address - Phone:408-375-7469
Mailing Address - Fax:
Practice Address - Street 1:5706 CAHALAN AVE # 23075
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3008
Practice Address - Country:US
Practice Address - Phone:408-375-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT121972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health