Provider Demographics
NPI:1184331159
Name:MOODY, KARISSA MORIAH (LMFT)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:MORIAH
Last Name:MOODY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17644 DELTA ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-5249
Mailing Address - Country:US
Mailing Address - Phone:720-385-6787
Mailing Address - Fax:
Practice Address - Street 1:5335 W 48TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2732
Practice Address - Country:US
Practice Address - Phone:970-446-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist