Provider Demographics
NPI:1942869870
Name:MOYES, KAROLINE CHAMBERLAIN
Entity Type:Individual
Prefix:
First Name:KAROLINE
Middle Name:CHAMBERLAIN
Last Name:MOYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAROLINE
Other - Middle Name:ROSE
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 N FAIRFIELD RD APT 14
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3323
Mailing Address - Country:US
Mailing Address - Phone:801-499-3214
Mailing Address - Fax:
Practice Address - Street 1:2940 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6614
Practice Address - Country:US
Practice Address - Phone:801-499-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician