Provider Demographics
NPI:1164238317
Name:MOODY, HANNAH (PPS)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1409
Mailing Address - Country:US
Mailing Address - Phone:209-408-2516
Mailing Address - Fax:
Practice Address - Street 1:710 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1409
Practice Address - Country:US
Practice Address - Phone:559-592-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210108661101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool