Provider Demographics
NPI:1730557240
Name:MOGA, ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MOGA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MOGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4595
Mailing Address - Street 2:
Mailing Address - City:ROLLINGBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98061-0595
Mailing Address - Country:US
Mailing Address - Phone:206-300-4412
Mailing Address - Fax:
Practice Address - Street 1:435 ERICKSEN AVE NE STE 240
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1896
Practice Address - Country:US
Practice Address - Phone:206-300-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH-60917362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health