Provider Demographics
NPI:1649872284
Name:MOFFITT, DESIREE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30767 GATEWAY PL STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1856
Mailing Address - Country:US
Mailing Address - Phone:949-409-5732
Mailing Address - Fax:
Practice Address - Street 1:511 6TH AVE # 7259
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8436
Practice Address - Country:US
Practice Address - Phone:949-409-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty