Provider Demographics
NPI:1881364610
Name:MOELLER, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MOELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 FRANKLIN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1865
Mailing Address - Country:US
Mailing Address - Phone:916-388-9418
Mailing Address - Fax:
Practice Address - Street 1:7000 FRANKLIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1865
Practice Address - Country:US
Practice Address - Phone:916-388-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-10-03
Deactivation Date:2024-09-13
Deactivation Code:
Reactivation Date:2024-10-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)