Individual
JOHN L MOULTON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH D
Contact information
Practice address
5905 LAKE EARL DRIVE, CRESCENT CITY, CA 95531
(707) 465-1000
Mailing address
P. O. BOX 1381, CRESCENT CITY, CA 95531
(707) 465-1000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY20637
CA
Other
Enumeration date
07/11/2006
Last updated
07/08/2007
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