Provider Demographics
NPI:1932658580
Name:MORENO, CASEY MCCONNELL
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MCCONNELL
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5508
Mailing Address - Country:US
Mailing Address - Phone:530-894-8008
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:130 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5508
Practice Address - Country:US
Practice Address - Phone:530-894-8008
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health