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Organization
NEWPORT MESA INDIVIDUAL AND FAMILY THERAPY
Active
Organization
NEWPORT MESA INDIVIDUAL AND FAMILY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIM D MOYERS DMIN (PRESIDENT)
(714) 273-9151
Entity
Organization
Contact information
Practice address
1300 BRISTOL ST N STE 216, NEWPORT BEACH, CA 92660-2952
(714) 273-9151
Mailing address
1300 BRISTOL ST N STE 216, NEWPORT BEACH, CA 92660-2952
(714) 273-9151
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
NULL
101YP1600X
Pastoral Counselor
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/02/2019
Last updated
09/02/2019
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