Provider Demographics
NPI:1184278004
Name:DR. KAYLA MOORER, PSYCHOLOGIST, LLC
Entity type:Organization
Organization Name:DR. KAYLA MOORER, PSYCHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:701-478-6604
Mailing Address - Street 1:1330 PAGE DR S STE 102A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3562
Mailing Address - Country:US
Mailing Address - Phone:701-478-6604
Mailing Address - Fax:701-478-6605
Practice Address - Street 1:1330 PAGE DR S STE 102A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3562
Practice Address - Country:US
Practice Address - Phone:701-478-6604
Practice Address - Fax:701-478-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)