Provider Demographics
NPI:1548658537
Name:MOORE, PETER (LMFT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
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:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-0074
Mailing Address - Country:US
Mailing Address - Phone:707-442-7228
Mailing Address - Fax:707-442-7228
Practice Address - Street 1:527 E ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0313
Practice Address - Country:US
Practice Address - Phone:707-442-7228
Practice Address - Fax:707-442-7228
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23507106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist