Provider Demographics
NPI:1649029174
Name:MOON, KELSEY (MS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 WOODSIDE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3438
Mailing Address - Country:US
Mailing Address - Phone:650-424-0852
Mailing Address - Fax:
Practice Address - Street 1:1779 WOODSIDE RD STE 200
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3438
Practice Address - Country:US
Practice Address - Phone:650-424-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)