Provider Demographics
NPI:1952176497
Name:MOORE, MEGAN TAYLOR (AMFT APPLICANT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:TAYLOR
Last Name:MOORE
Suffix:
Gender:F
Credentials:AMFT APPLICANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 INDUSTRIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5024
Mailing Address - Country:US
Mailing Address - Phone:916-267-7384
Mailing Address - Fax:
Practice Address - Street 1:3960 INDUSTRIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5024
Practice Address - Country:US
Practice Address - Phone:916-267-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health