Individual
GORDON MOOR WHEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
302 MOORE ST, SANTA CRUZ, CA 95060-2516
(831) 917-1676
Mailing address
302 MOORE ST, SANTA CRUZ, CA 95060-2516
(831) 917-1676
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
6509
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6509
LICD PSYCHOLOGIST PROVIDER
MA
Enumeration date
06/23/2018
Last updated
06/23/2018
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