Provider Demographics
NPI:1891293817
Name:MOLER, KEVIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:MOLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S 367TH AVE
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:AZ
Mailing Address - Zip Code:85354-7791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4242
Practice Address - Country:US
Practice Address - Phone:623-487-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional