Provider Demographics
NPI:1396769675
Name:MOORE, SHARON HELEN (MFT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:HELEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 WHITWORTH DRIVE
Mailing Address - Street 2:#3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6540
Mailing Address - Country:US
Mailing Address - Phone:310-967-2020
Mailing Address - Fax:
Practice Address - Street 1:6017 WHITWORTH DRIVE
Practice Address - Street 2:#3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6540
Practice Address - Country:US
Practice Address - Phone:310-967-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist