Provider Demographics
NPI:1194174698
Name:MOORE, BRITTANY LEANN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30141 ANTELOPE RD STE D
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30141 ANTELOPE RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7001
Practice Address - Country:US
Practice Address - Phone:951-704-6219
Practice Address - Fax:951-848-9292
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist