Provider Demographics
NPI:1396114617
Name:MORELAND, NICOLE (AMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 HAVEN AVE APT 5102
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1088
Mailing Address - Country:US
Mailing Address - Phone:831-277-0395
Mailing Address - Fax:
Practice Address - Street 1:375 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306
Practice Address - Country:US
Practice Address - Phone:650-326-6576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program