# PEDIATRIC & FAMILY PSYCHOLOGY CENTER PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** CH Moore PhD dba Pediatric & Family Psychology Center PA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104826510
- **Authorized official:** DR. C L MOORE PHD (OWNER)
- **Authorized official phone:** (651) 771-4766

## Contact information

- **Practice address:** 2440 N CHARLES STREET, SUITE 236, NORTH SAINT PAUL, MN 55109-3050
- **Practice address phone:** (651) 771-4766
- **Practice address fax:** (651) 771-4784
- **Mailing address:** 2440 N CHARLES STREET, SUITE 236, NORTH SAINT PAUL, MN 55109-3050
- **Mailing address phone:** (651) 771-4766
- **Mailing address fax:** (651) 771-4784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 440 | CO | — |
| 103T00000X | Psychologist | LP2246 | MN | — |
| 103T00000X | Psychologist | PY00000625 | WA | — |
| 106H00000X | Marriage & Family Therapist | 1 | MN | Yes |

## Other

- **Enumeration date:** 07/28/2005
- **Last updated:** 09/11/2025