Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MJ12300 | CA |
N | 101YM0800X | Mental Health Counselor | LMFCT12300 | CA |
Y | 101YP2500X | Professional Counselor | M12300 | CA |
N | 103K00000X | Behavior Analyst | M12300 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | M12300 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | M12300 | CA |
N | 103G00000X | Clinical Psychologist | M12300 | CA |
N | 103TC0700X | Clinical Psychologist | M12300 | CA |
N | 103TC1900X | Counseling Psychologist | M12300 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | M12300 | CA |
N | 103TF0000X | Family Psychologist | M12300 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | M12300 | CA |
N | 174V00000X | Clinical Ethicist | LMFT12300 | CA |
NPI | 1801212584 |
---|---|
Provider Name | Jeanne Moore |
First Address | Bakersfield, CA 93384-0693 |
Second Address | Bakersfield, CA 93304-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 28/04/2015 |